Healthcare Provider Details

I. General information

NPI: 1750784906
Provider Name (Legal Business Name): PENNYROYAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TAN OAK AVE
CAMP MEEKER CA
95419
US

IV. Provider business mailing address

PO BOX 131
CAMP MEEKER CA
95419-0131
US

V. Phone/Fax

Practice location:
  • Phone: 707-812-6683
  • Fax: 707-294-6289
Mailing address:
  • Phone: 707-812-6683
  • Fax: 707-294-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. IVY ROSE HUNTER
Title or Position: CHEIF EXECUTIVE OFFICER
Credential: R.N.
Phone: 707-812-6683