Provider Demographics
NPI:1972837102
Name:PATTY'S HOMEFRONT, INC.
Entity type:Organization
Organization Name:PATTY'S HOMEFRONT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:OBIAGELI
Authorized Official - Last Name:KANU
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:806-368-3323
Mailing Address - Street 1:4423 110TH ST
Mailing Address - Street 2:UNIT 18
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7328
Mailing Address - Country:US
Mailing Address - Phone:806-368-3323
Mailing Address - Fax:
Practice Address - Street 1:4423 110TH ST UNIT 18
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7329
Practice Address - Country:US
Practice Address - Phone:806-368-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)