Provider Demographics
NPI:1902409097
Name:CARTER, PENNY (HOME CARE PROVIDER)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SUNFISH ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:45612-9659
Mailing Address - Country:US
Mailing Address - Phone:740-253-5784
Mailing Address - Fax:
Practice Address - Street 1:260 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1603
Practice Address - Country:US
Practice Address - Phone:740-253-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker