Potters House PNCC Services

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

POTTERS HOUSE PNCC SERVICES

Practice address

2110 W National Ave
Milwaukee, WI 53204-1159

Phone

(414) 940-8564

Fax

(414) 810-0523

NPI assigned

May 21, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Dequana Bostick

Title

Owner

Phone

(414) 419-1025

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1790350908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 S 18TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532041125",
            "telephone_number": "414-419-1025",
            "fax_number": "414-810-0523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 W NATIONAL AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532041159",
            "telephone_number": "414-940-8564",
            "fax_number": "414-810-0523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTTERS HOUSE PNCC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "BOSTICK",
        "authorized_official_first_name": "DEQUANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-419-1025",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Audrey L Potter, PHD
• Kaylee Grace Potter, DO
• Mary Claire Potter
• Ryan Potter
• Potter'S House Care LLC
• Elizabeth Potthast
• Jessica Pottinger, BCABA
• Leah Poulos, MD
• Michael Poulson, MD
• Gregory A. Poulton, PA-C

• Case Management Agency in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Case Management Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.