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General NPI Number Information
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NPI Number | 1265979975
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Entity Type | Organization
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Legal Business Name | PENDER ADULT SERVICES, INC.
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 901 S. WALKER ST
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City | BURGAW
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State | NC
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Zip | 28425-5009
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Country | US
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Telephone | 910-259-9119
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1251
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City | BURGAW
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State | NC
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Zip | 28425-1251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WESLEY B. DAVIS
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Credential |
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Telephone | 910-259-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | HC0786
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License Number State | NC
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