Provider Demographics
NPI:1912692864
Name:YVETTES PAMPERED PNCC SERVICES LLC
Entity type:Organization
Organization Name:YVETTES PAMPERED PNCC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHE-RA
Authorized Official - Middle Name:LATOYA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-303-1269
Mailing Address - Street 1:4632 S 20TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2878
Mailing Address - Country:US
Mailing Address - Phone:414-303-1269
Mailing Address - Fax:
Practice Address - Street 1:4632 S 20TH ST APT 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-2878
Practice Address - Country:US
Practice Address - Phone:414-303-1269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management