Provider Demographics
NPI:1629352075
Name:PENAMA, INCORPORATED
Entity Type:Organization
Organization Name:PENAMA, INCORPORATED
Other - Org Name:LA EPOCA DE ORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-722-5468
Mailing Address - Street 1:2801 MUSSER ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-2441
Mailing Address - Country:US
Mailing Address - Phone:956-722-5468
Mailing Address - Fax:956-722-8819
Practice Address - Street 1:1002 PASEO DE TIBER
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-7642
Practice Address - Country:US
Practice Address - Phone:956-791-1480
Practice Address - Fax:956-791-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home