Provider Demographics
NPI:1366424897
Name:PDN, INC.
Entity type:Organization
Organization Name:PDN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONOR
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SKRNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-604-4550
Mailing Address - Street 1:10278 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4603
Mailing Address - Country:US
Mailing Address - Phone:228-604-4550
Mailing Address - Fax:228-604-4656
Practice Address - Street 1:10281 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4603
Practice Address - Country:US
Practice Address - Phone:228-604-4550
Practice Address - Fax:228-604-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00014113Medicaid