Provider Demographics
NPI:1447962998
Name:ANOINTED JOURNEY PNCC LLC
Entity type:Organization
Organization Name:ANOINTED JOURNEY PNCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAZMINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-366-6947
Mailing Address - Street 1:3202 N 76TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3958
Mailing Address - Country:US
Mailing Address - Phone:414-366-6947
Mailing Address - Fax:
Practice Address - Street 1:3202 N 76TH ST APT 7
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3958
Practice Address - Country:US
Practice Address - Phone:414-366-6947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health