Provider Demographics
NPI:1811714066
Name:PENNINGTON-WILLIAMS, LITA
Entity type:Individual
Prefix:
First Name:LITA
Middle Name:
Last Name:PENNINGTON-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3312
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93912-3312
Mailing Address - Country:US
Mailing Address - Phone:831-632-2200
Mailing Address - Fax:831-632-2060
Practice Address - Street 1:11899 CYPRESS CIR
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95012-3015
Practice Address - Country:US
Practice Address - Phone:831-632-2200
Practice Address - Fax:831-632-2060
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275200867310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility