Provider Demographics
NPI:1356540637
Name:PENDER COUNTY DEPT OF SOCIAL SERVICES
Entity type:Organization
Organization Name:PENDER COUNTY DEPT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RETA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPA
Authorized Official - Phone:910-259-1240
Mailing Address - Street 1:810 S WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5000
Mailing Address - Country:US
Mailing Address - Phone:910-259-1240
Mailing Address - Fax:910-259-1418
Practice Address - Street 1:810 S WALKER ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5000
Practice Address - Country:US
Practice Address - Phone:910-259-1240
Practice Address - Fax:910-259-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0694251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700042Medicaid