Provider Demographics
NPI:1417578402
Name:PENIEL HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:PENIEL HEALTH SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WAVENEY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LAGRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-661-2730
Mailing Address - Street 1:PO BOX 133372
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-3372
Mailing Address - Country:US
Mailing Address - Phone:832-661-2730
Mailing Address - Fax:281-547-8220
Practice Address - Street 1:9331 STABLEWOOD LAKES LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1279
Practice Address - Country:US
Practice Address - Phone:832-661-2730
Practice Address - Fax:281-547-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health