Provider Demographics
NPI:1851043756
Name:PANHANDLE ACTIVITY CENTER LLC
Entity Type:Organization
Organization Name:PANHANDLE ACTIVITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEFFREYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-532-2273
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PANHANDLE
Mailing Address - State:TX
Mailing Address - Zip Code:79068-0010
Mailing Address - Country:US
Mailing Address - Phone:806-310-9855
Mailing Address - Fax:806-310-9857
Practice Address - Street 1:1600 S FM 2381
Practice Address - Street 2:
Practice Address - City:BUSHLAND
Practice Address - State:TX
Practice Address - Zip Code:79124-1900
Practice Address - Country:US
Practice Address - Phone:806-310-9855
Practice Address - Fax:806-310-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty