Provider Demographics
NPI:1639760051
Name:WENZY'S PLACE PERSONAL CARE LLC
Entity Type:Organization
Organization Name:WENZY'S PLACE PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:832-943-0709
Mailing Address - Street 1:15502 HUDDLESTON DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6059
Mailing Address - Country:US
Mailing Address - Phone:832-943-0709
Mailing Address - Fax:
Practice Address - Street 1:10927 BARKER GATE CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2341
Practice Address - Country:US
Practice Address - Phone:832-943-0709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WENZY'S PLACE PERSONAL CARE HOME LLC MOBILE LAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory