Provider Demographics
| NPI: | 1093251928 |
|---|---|
| Name: | WIHELMENA CARE CENTER |
| Entity Type: | Organization |
| Organization Name: | WIHELMENA CARE CENTER |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/MANAGER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | PEGGY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PENN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | BSN, MBA/HCM |
| Authorized Official - Phone: | 832-621-9359 |
| Mailing Address - Street 1: | 5301 BRETT DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PEARLAND |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77584-1236 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 832-621-9359 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 9502 ROSEHAVEN DR |
| Practice Address - Street 2: | |
| Practice Address - City: | HOUSTON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77051-3131 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 832-621-9359 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | CHANNEL OF HOPE OUTREACH |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2017-01-17 |
| Last Update Date: | 2017-01-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | 666663 | 261QA0600X, 261QH0100X, 3104A0630X, 311500000X, 311Z00000X, 311ZA0620X, 313M00000X, 332B00000X, 332BN1400X, 332BX2000X, 3416L0300X, 343800000X, 343900000X, 385H00000X, 385HR2060X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
| No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 311500000X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | |
| No | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility | |
| No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
| No | 313M00000X | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | |
| No | 332BN1400X | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies |
| No | 332BX2000X | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
| No | 3416L0300X | Transportation Services | Ambulance | Land Transport |
| No | 343800000X | Transportation Services | Secured Medical Transport (VAN) | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | |
| No | 385H00000X | Respite Care Facility | Respite Care | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
