Provider Demographics
NPI:1316310204
Name:PENNIX TENDER HOME CARE
Entity type:Organization
Organization Name:PENNIX TENDER HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PENNIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-610-3076
Mailing Address - Street 1:11055 STONEWALL RD
Mailing Address - Street 2:
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-8589
Mailing Address - Country:US
Mailing Address - Phone:434-610-3076
Mailing Address - Fax:
Practice Address - Street 1:11055 STONEWALL RD
Practice Address - Street 2:
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522-8589
Practice Address - Country:US
Practice Address - Phone:434-610-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health