Provider Demographics
NPI:1972847382
Name:PENNYMARIE ENTERPRISES, LLC
Entity type:Organization
Organization Name:PENNYMARIE ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-723-3924
Mailing Address - Street 1:3803 S CAULDER WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6239
Mailing Address - Country:US
Mailing Address - Phone:281-723-3924
Mailing Address - Fax:
Practice Address - Street 1:4007 BELLAIRE BLVD
Practice Address - Street 2:SUITE GG
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1166
Practice Address - Country:US
Practice Address - Phone:281-362-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613434163WC1500X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty