Provider Demographics
NPI:1750784906
Name:PENNYROYAL CARE
Entity type:Organization
Organization Name:PENNYROYAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:707-812-6683
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:CAMP MEEKER
Mailing Address - State:CA
Mailing Address - Zip Code:95419-0131
Mailing Address - Country:US
Mailing Address - Phone:707-812-6683
Mailing Address - Fax:707-294-6289
Practice Address - Street 1:150 TAN OAK AVE
Practice Address - Street 2:
Practice Address - City:CAMP MEEKER
Practice Address - State:CA
Practice Address - Zip Code:95419
Practice Address - Country:US
Practice Address - Phone:707-812-6683
Practice Address - Fax:707-294-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care