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General NPI Number Information
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NPI Number | 1972837102
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Entity Type | Organization
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Legal Business Name | PATTY'S HOMEFRONT, INC.
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 4423 110TH ST UNIT 18
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City | LUBBOCK
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State | TX
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Zip | 79424-7329
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Country | US
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Telephone | 806-368-3323
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Fax |
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Provider Business Mailing Address
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Address Line | 4423 110TH ST UNIT 18
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City | LUBBOCK
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State | TX
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Zip | 79424-7328
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Country | US
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Telephone | 806-368-3323
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | PATRICIA OBIAGELI KANU
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Credential | M.ED
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Telephone | 806-368-3323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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