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General NPI Number Information
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NPI Number | 1215776422
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Entity Type | Organization
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Legal Business Name | PENBERTHYHOLDINGS, LLC
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 102 BAILEY ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1819
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Country | US
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Telephone | 573-756-6374
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Fax |
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Provider Business Mailing Address
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Address Line | 7164 ROSEMARY LN
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City | CEDAR HILL
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State | MO
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Zip | 63016-3130
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Country | US
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Telephone | 314-315-6272
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Fax | 314-475-1913
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Authorized Official
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Title or Position | OWNER
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Name | BRANDON PENBERTHY
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Credential |
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Telephone | 314-315-6272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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