Provider Demographics
NPI:1346217676
Name:PENDER MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:PENDER MEMORIAL HOSPITAL, INC
Other - Org Name:PENDER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SITE EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:SEO
Authorized Official - Phone:910-259-5451
Mailing Address - Street 1:507 E FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5131
Mailing Address - Country:US
Mailing Address - Phone:910-259-5451
Mailing Address - Fax:
Practice Address - Street 1:507 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5131
Practice Address - Country:US
Practice Address - Phone:910-259-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENDER MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-06
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0532251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0070NOtherBCBS NC PROVIDER NUMBER
NC3417065Medicaid
NC3417065Medicaid