Healthcare Provider Details

I. General information

NPI: 1689672115
Provider Name (Legal Business Name): PENDLETON MANOR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/21/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 GOOD SAMARITAN DRIVE
FRANKLIN WV
26807-0700
US

IV. Provider business mailing address

68 GOOD SAMARITAN DRIVE PO BOX 700
FRANKLIN WV
26807-0700
US

V. Phone/Fax

Practice location:
  • Phone: 304-358-2320
  • Fax: 304-358-3746
Mailing address:
  • Phone: 304-358-2320
  • Fax: 304-358-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICKIE D BENNETT
Title or Position: DIRECTOR OF HOME HEALTH
Credential: RN, BSN
Phone: 304-358-2320