Provider Demographics
NPI:1295547834
Name:PENDA HOMECARE LLC
Entity type:Organization
Organization Name:PENDA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMINYEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-483-6656
Mailing Address - Street 1:3455 KEARNY VILLA RD APT 129
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1974
Mailing Address - Country:US
Mailing Address - Phone:619-483-6656
Mailing Address - Fax:
Practice Address - Street 1:3455 KEARNY VILLA RD APT 129
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1974
Practice Address - Country:US
Practice Address - Phone:619-483-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health