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General NPI Number Information
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NPI Number | 1336163013
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Entity Type | Organization
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Legal Business Name | PENTADOYEN LLC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 8241 S WALKER AVE SUITE 152
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9401
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Country | US
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Telephone | 405-525-0118
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Fax | 405-525-3172
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Provider Business Mailing Address
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Address Line | 8241 S WALKER AVE SUITE 152
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9401
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Country | US
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Telephone | 405-525-0118
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Fax | 405-525-3172
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL L CHARBONEAU
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Credential |
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Telephone | 405-525-0118
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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 | 7825
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License Number State | OK
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