1689672115 NPI number — PENDLETON MANOR, INC

Table of content: (NPI 1689672115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689672115 NPI number — PENDLETON MANOR, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENDLETON MANOR, 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:
PENDLETON HOME HEALTH SERVICES
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:
1689672115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 GOOD SAMARITAN DRIVE
Provider Second Line Business Mailing Address:
PO BOX 700
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26807-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-358-2320
Provider Business Mailing Address Fax Number:
304-358-3746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 GOOD SAMARITAN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26807-0700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-358-2320
Provider Business Practice Location Address Fax Number:
304-358-3746
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
VICKIE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR OF HOME HEALTH
Authorized Official Telephone Number:
304-358-2320

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0003817001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com