Healthcare Provider Details

I. General information

NPI: 1316857204
Provider Name (Legal Business Name): PANDA CARE TEXAS SUB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 SYLVAN AVE STE 2260
ENGLEWOOD CLIFFS NJ
07632
US

IV. Provider business mailing address

270 SYLVAN AVE STE 2260
ENGLEWOOD CLIFFS NJ
07632-2561
US

V. Phone/Fax

Practice location:
  • Phone: 313-284-2501
  • Fax:
Mailing address:
  • Phone: 313-284-2501
  • Fax: 313-462-0017

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: VICKI DRAZIN
Title or Position: OWNER
Credential:
Phone: 313-284-2501