Provider Demographics
NPI:1215776422
Name:PENBERTHYHOLDINGS, LLC
Entity type:Organization
Organization Name:PENBERTHYHOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:PENBERTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-315-6272
Mailing Address - Street 1:7164 ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-3130
Mailing Address - Country:US
Mailing Address - Phone:314-315-6272
Mailing Address - Fax:314-475-1913
Practice Address - Street 1:102 BAILEY ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1819
Practice Address - Country:US
Practice Address - Phone:573-756-6374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility