Provider Demographics
NPI:1376160143
Name:PENDARVIS, HELEN MELETTE
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:MELETTE
Last Name:PENDARVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MILLPORT CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5573
Mailing Address - Country:US
Mailing Address - Phone:864-315-1762
Mailing Address - Fax:
Practice Address - Street 1:128 MILLPORT CIR STE 200
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5573
Practice Address - Country:US
Practice Address - Phone:864-315-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCO-1222251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCIHCP-1222OtherSC DHEC