Provider Demographics
NPI:1720139900
Name:PENACO HOME HEALTH CARE
Entity Type:Organization
Organization Name:PENACO HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHINELO
Authorized Official - Middle Name:OGBONNE
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:BSC MICROBIOLOGY
Authorized Official - Phone:281-703-7389
Mailing Address - Street 1:14111 TORREY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1829
Mailing Address - Country:US
Mailing Address - Phone:281-586-9616
Mailing Address - Fax:281-586-9292
Practice Address - Street 1:14111 TORREY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1829
Practice Address - Country:US
Practice Address - Phone:281-586-9616
Practice Address - Fax:281-586-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health