1427307222 NPI number — PENDLETON COMMUNITY CARE, INC.

Table of content: (NPI 1427307222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427307222 NPI number — PENDLETON COMMUNITY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENDLETON COMMUNITY CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARMAN HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427307222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO DRAWER 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARMAN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26270-0014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-227-4134
Provider Business Mailing Address Fax Number:
304-227-4522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MOTT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARMAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26270-0014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-227-4134
Provider Business Practice Location Address Fax Number:
304-227-4522
Provider Enumeration Date:
09/07/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
304-358-2355

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810026188 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".