Healthcare Provider Details

I. General information

NPI: 1902711625
Provider Name (Legal Business Name): PENROSE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13137 CHAMPAIGN AVE
WARREN MI
48089-4504
US

IV. Provider business mailing address

2137 HARTEL AVE
PHILADELPHIA PA
19152-3706
US

V. Phone/Fax

Practice location:
  • Phone: 267-367-0123
  • Fax:
Mailing address:
  • Phone: 267-367-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MD DOSTGIR KHAN NOFAYEL
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 267-367-0123