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General NPI Number Information
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NPI Number | 1366610321
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Entity Type | Organization
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Legal Business Name | PENTA GROUP INC.
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 300 SCHOONOVER DRIVE
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City | SALEM
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State | IL
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Zip | 62881
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Country | US
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Telephone | 618-548-4561
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1946
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City | CENTRALIA
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State | IL
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Zip | 62801-9127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GEORGIA MILLER
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Credential |
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Telephone | 618-548-4561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 002
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License Number State | IL
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