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General NPI Number Information
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NPI Number | 1629352075
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Entity Type | Organization
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Legal Business Name | PENAMA, INCORPORATED
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 1002 PASEO DE TIBER
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City | LAREDO
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State | TX
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Zip | 78046-7642
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Country | US
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Telephone | 956-791-1480
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Fax | 956-791-1481
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Provider Business Mailing Address
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Address Line | 2801 MUSSER ST
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City | LAREDO
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State | TX
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Zip | 78043-2441
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Country | US
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Telephone | 956-722-5468
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Fax | 956-722-8819
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. MARIA LUISA PENA
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Credential |
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Telephone | 956-722-5468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | TX
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