Provider Demographics
NPI:1205006673
Name:PENJAMO INC.
Entity Type:Organization
Organization Name:PENJAMO INC.
Other - Org Name:OUR BROTHER'S KEEPER PROVIDER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PAS
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALONSO
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-562-1068
Mailing Address - Street 1:PO BOX 1758
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-1758
Mailing Address - Country:US
Mailing Address - Phone:361-562-1068
Mailing Address - Fax:
Practice Address - Street 1:308 COUNTY ROAD 140
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-7636
Practice Address - Country:US
Practice Address - Phone:361-562-1068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010736251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health