Provider Demographics
NPI:1982012761
Name:PENDLETON SENIOR & FAMILY SERVICES
Entity Type:Organization
Organization Name:PENDLETON SENIOR & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FULLTIME RN
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-358-2421
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:231 MILL ROAD
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-0009
Mailing Address - Country:US
Mailing Address - Phone:304-358-2421
Mailing Address - Fax:304-358-2422
Practice Address - Street 1:231 MILL ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-0009
Practice Address - Country:US
Practice Address - Phone:304-358-2421
Practice Address - Fax:304-358-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV046616253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care