Provider Demographics
NPI:1538137468
Name:PENDER MEMORIAL HOSPITAL, INCORPORATED
Entity Type:Organization
Organization Name:PENDER MEMORIAL HOSPITAL, INCORPORATED
Other - Org Name:NOVANT HEALTH PENDER MEDICAL CENTER SNF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-300-4004
Mailing Address - Street 1:507 EAST FREMONT STREET
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:910-300-4003
Mailing Address - Fax:910-259-6182
Practice Address - Street 1:507 EAST FREMONT STREET
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:910-300-4003
Practice Address - Fax:910-259-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0115314000000X
NCHC0115314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405245Medicaid
NC00990OtherSNF BCBS PROVIDER NUM
NC00990OtherSNF BCBS PROVIDER NUM
NC345245Medicare UPIN