Provider Demographics
NPI:1720979933
Name:MOMMIEWORKS PNCC
Entity type:Organization
Organization Name:MOMMIEWORKS PNCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-502-3021
Mailing Address - Street 1:6969 N PORT WASHINGTON RD STE 150B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3949
Mailing Address - Country:US
Mailing Address - Phone:414-502-3021
Mailing Address - Fax:
Practice Address - Street 1:1037 W MCKINLEY AVE STE 314
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2530
Practice Address - Country:US
Practice Address - Phone:414-502-3021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LIVING QUARTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management