Provider Demographics
NPI:1427421262
Name:PETRA HEALTH CARE LLC
Entity type:Organization
Organization Name:PETRA HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-828-8322
Mailing Address - Street 1:331 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3734
Mailing Address - Country:US
Mailing Address - Phone:978-828-8322
Mailing Address - Fax:
Practice Address - Street 1:331 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-3734
Practice Address - Country:US
Practice Address - Phone:978-828-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETRA HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health