Provider Demographics
NPI:1679281109
Name:FAMILY 1ST PNCC SERVICES, LLC.
Entity type:Organization
Organization Name:FAMILY 1ST PNCC SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH EDUCATOR/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-520-6574
Mailing Address - Street 1:4435 N 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5702
Mailing Address - Country:US
Mailing Address - Phone:414-520-6574
Mailing Address - Fax:
Practice Address - Street 1:4435 N 49TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5702
Practice Address - Country:US
Practice Address - Phone:414-520-6574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty