Organization
GRAND RISING PNCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIQUITA S SHADWICK (CEO)
(414) 526-1431
Entity
Organization
Contact information
Practice address
1620 N 29TH ST, MILWAUKEE, WI 53208-2009
(414) 526-1541
Mailing address
1620 N 29TH ST, MILWAUKEE, WI 53208-2009
(414) 526-1431
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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