=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275368664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENDA HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2024
-----------------------------------------------------
Last Update Date | 09/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40968 W PORTIS DR
-----------------------------------------------------
City | MARICOPA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85138-4569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-457-7645
-----------------------------------------------------
Fax | 520-423-3381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 BURNHAM DR
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565-7208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-698-9281
-----------------------------------------------------
Fax | 520-423-3381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MS. ASHA M MADOSHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-698-9281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------