Provider Demographics
NPI:1396442240
Name:PENNY LANE ASSISTED CARE LLC
Entity type:Organization
Organization Name:PENNY LANE ASSISTED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMSHED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-319-2914
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-0012
Mailing Address - Country:US
Mailing Address - Phone:978-343-7400
Mailing Address - Fax:
Practice Address - Street 1:222 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7939
Practice Address - Country:US
Practice Address - Phone:978-343-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging