MEDICARE: PLENITUD INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1346557188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLENITUD INC.

Provider Business Mailing Address
First Line	:	2431 MONTANA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-3642
Country	:	US
Telephone Number	:	915-851-4663
Fax Number	:	915-851-0899

Provider Business Practice Location Address
First Line	:	2431 MONTANA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-3642
Country	:	US
Telephone Number	:	915-851-4663
Fax Number	:	915-851-0899

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MANUEL HECTOR GONZALEZ JR.
Credential	:
Telephone Number	:	915-851-4663

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	08/31/2010

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