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General NPI Number Information
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NPI Number | 1568514057
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Entity Type | Organization
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Legal Business Name | PENDER ADULT SERVICE, INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/21/2022
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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 | 910-259-9144
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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 | 910-259-9119
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Fax | 910-259-9144
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. 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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 3408224
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3408224
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | NC
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