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General NPI Number Information
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NPI Number | 1205006673
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Entity Type | Organization
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Legal Business Name | PENJAMO INC.
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Dates
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Enumeration Date | 03/02/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 308 COUNTY ROAD 140
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City | ALICE
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State | TX
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Zip | 78332-7636
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Country | US
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Telephone | 361-562-1068
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1758
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City | ALICE
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State | TX
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Zip | 78333-1758
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Country | US
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Telephone | 361-562-1068
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Fax |
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Authorized Official
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Title or Position | DIR OF PAS
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Name | MR. LUIS ALONSO SILVA
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Credential |
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Telephone | 361-562-1068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010736
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License Number State | TX
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