Provider Demographics
NPI:1548688534
Name:PENDER CARE CENTRE DISTRICT INC
Entity type:Organization
Organization Name:PENDER CARE CENTRE DISTRICT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-385-3083
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PENDER
Mailing Address - State:NE
Mailing Address - Zip Code:68047-0628
Mailing Address - Country:US
Mailing Address - Phone:402-385-3350
Mailing Address - Fax:402-385-0155
Practice Address - Street 1:958 WELLNESS WAY STE 2
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047-4518
Practice Address - Country:US
Practice Address - Phone:402-385-3350
Practice Address - Fax:402-385-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NE5673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145442OtherPK
7378540001Medicare NSC