Healthcare Provider Details

I. General information

NPI: 1982673034
Provider Name (Legal Business Name): PENDER MEMORIAL HOSPITAL, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E FREMONT ST
BURGAW NC
28425-5131
US

IV. Provider business mailing address

507 E FREMONT ST
BURGAW NC
28425-5131
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-5451
  • Fax:
Mailing address:
  • Phone: 910-259-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberH0115
License Number StateNC

VIII. Authorized Official

Name: MR. DAVID H. LONG
Title or Position: ADMINISTRATOR/SITE EXECUTIVE OFFICE
Credential:
Phone: 910-259-5451