Provider Demographics
NPI:1720498728
Name:PENROSE AVENUE LLC
Entity Type:Organization
Organization Name:PENROSE AVENUE LLC
Other - Org Name:PENROSE SENIOR CARE AUDITORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:866-894-8488
Mailing Address - Street 1:6224 PENROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3040
Mailing Address - Country:US
Mailing Address - Phone:866-894-8488
Mailing Address - Fax:
Practice Address - Street 1:6224 PENROSE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3040
Practice Address - Country:US
Practice Address - Phone:866-894-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care