MEDICARE: MR. ANTHONY PENDLETON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	385HR2055X	Child Mental Illness Respite Care
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	385HR2065X	Child Physical Disabilities Respite Care
4	385H00000X	Respite Care

General Provider Information

NPI Number	:	1801764568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY PENDLETON

Provider Business Mailing Address
First Line	:	2969 MARTIN LUTHER KING JR DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4865
Country	:	US
Telephone Number	:	216-507-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	2969 MARTIN LUTHER KING JR DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4865
Country	:	US
Telephone Number	:	216-507-1030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2025
Last Update Date	:	10/30/2025

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Directions to “ MR. ANTHONY PENDLETON ” Practice Location

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