Healthcare Provider Details

I. General information

NPI: 1366424897
Provider Name (Legal Business Name): PDN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10281 CORPORATE DR
GULFPORT MS
39503-4603
US

IV. Provider business mailing address

10278 CORPORATE DRIVE
GULFPORT MS
39503-4603
US

V. Phone/Fax

Practice location:
  • Phone: 228-604-4550
  • Fax: 228-604-4656
Mailing address:
  • Phone: 228-604-4550
  • Fax: 228-604-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONOR LYNN SKRNICH
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 228-604-4550