Provider Demographics
NPI:1932524428
Name:PEN-CARE, INC.
Entity Type:Organization
Organization Name:PEN-CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENMENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-308-5823
Mailing Address - Street 1:12120 COONEY DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-8619
Mailing Address - Country:US
Mailing Address - Phone:815-308-5823
Mailing Address - Fax:815-206-0320
Practice Address - Street 1:12120 COONEY DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-8619
Practice Address - Country:US
Practice Address - Phone:815-308-5823
Practice Address - Fax:815-206-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000364253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care