Healthcare Provider Details

I. General information

NPI: 1093813842
Provider Name (Legal Business Name): PENSLOW HEALTH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N DYSON ST
HOLLY RIDGE NC
28445
US

IV. Provider business mailing address

PO BOX 159
HOLLY RIDGE NC
28445
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-7591
  • Fax: 910-329-1592
Mailing address:
  • Phone: 910-329-7591
  • Fax: 910-329-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERYL B HINES
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-329-7591