MEDICARE: PANACEB ENTERPRISE LLC

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	253Z00000X	In Home Supportive Care Agency	014090	TX

General Provider Information

NPI Number	:	1982992558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANACEB ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	3901 ARLINGTON HIGHLANDS BLVD
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	TX
Zip	:	76018-6036
Country	:	US
Telephone Number	:	817-374-4300
Fax Number	:	817-704-4657

Provider Business Practice Location Address
First Line	:	3901 ARLINGTON HIGHLANDS BLVD
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	TX
Zip	:	76018-6036
Country	:	US
Telephone Number	:	817-374-4300
Fax Number	:	817-704-4657

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOSE ANDY CEBALLOS
Credential	:
Telephone Number	:	817-374-4300

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	03/17/2015

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Directions to “PANACEB ENTERPRISE LLC ” Practice Location

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