Healthcare Provider Details

I. General information

NPI: 1699528026
Provider Name (Legal Business Name): PATRICIA PENNYMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 MARQUETTE ST APT 909
WESTLAND MI
48185-3248
US

IV. Provider business mailing address

332 BROOKFIELD DR
WESTLAND MI
48185-3831
US

V. Phone/Fax

Practice location:
  • Phone: 313-570-9532
  • Fax:
Mailing address:
  • Phone: 313-570-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: