Healthcare Provider Details

I. General information

NPI: 1255772752
Provider Name (Legal Business Name): PENDLETON PLACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 PENDLETON ST
GREENVILLE SC
29601-2317
US

IV. Provider business mailing address

PO BOX 10323
GREENVILLE SC
29603-0323
US

V. Phone/Fax

Practice location:
  • Phone: 864-467-3650
  • Fax: 864-467-3645
Mailing address:
  • Phone: 864-467-3650
  • Fax: 864-467-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateSC

VIII. Authorized Official

Name: MS. LAURIE ROVIN
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW, MA
Phone: 864-516-1225