Provider Demographics
NPI:1821413287
Name:PEDIATRIC PRIVATE DUTY NURSING, INC
Entity Type:Organization
Organization Name:PEDIATRIC PRIVATE DUTY NURSING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-710-0588
Mailing Address - Street 1:25315 BOERNE STAGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-9526
Mailing Address - Country:US
Mailing Address - Phone:210-251-4316
Mailing Address - Fax:210-251-4062
Practice Address - Street 1:25315 BOERNE STAGE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-9526
Practice Address - Country:US
Practice Address - Phone:210-251-4316
Practice Address - Fax:210-251-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN #