MEDICARE: PELEBO HOME VISITS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1316389943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELEBO HOME VISITS LLC

Provider Business Mailing Address
First Line	:	1515 HERITAGE DR STE 110
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-3379
Country	:	US
Telephone Number	:	855-860-2109
Fax Number	:	855-814-8428

Provider Business Practice Location Address
First Line	:	303 S MAIN ST
Second Line	:
City	:	COPPERAS COVE
State	:	TX
Zip	:	76522-2237
Country	:	US
Telephone Number	:	254-542-2486
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JUDY POSTLE
Credential	:
Telephone Number	:	855-860-2109

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	08/13/2013

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