Provider Demographics
NPI:1356772321
Name:PG AND S, LLC
Entity type:Organization
Organization Name:PG AND S, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MBAEMBER
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:DAVID-WUAM
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:505-903-1671
Mailing Address - Street 1:10517 CAROL PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5305
Mailing Address - Country:US
Mailing Address - Phone:505-903-1671
Mailing Address - Fax:
Practice Address - Street 1:10517 CAROL PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5305
Practice Address - Country:US
Practice Address - Phone:505-903-1671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4796330251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care