Provider Demographics
NPI:1336403278
Name:PENNELL HEALTHCARE LLC
Entity Type:Organization
Organization Name:PENNELL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LEMME
Authorized Official - Last Name:MBOUGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-899-2500
Mailing Address - Street 1:2525 OAKSTONE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-8625
Mailing Address - Country:US
Mailing Address - Phone:614-899-2500
Mailing Address - Fax:614-899-2509
Practice Address - Street 1:2525 OAKSTONE DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-8625
Practice Address - Country:US
Practice Address - Phone:614-899-2500
Practice Address - Fax:614-899-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2103421251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health