# PENNY GENEVIEVE HARGROVE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wings I
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437287828
- **Authorized official:** PENNY HARGROVE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (925) 754-5184

## Contact information

- **Practice address:** 2427 DESRYS BLVD, ANTIOCH, CA 94509-4324
- **Practice address phone:** (925) 776-8386
- **Mailing address:** P.O. BOX 1295, ANTIOCH, CA 94509-0129
- **Mailing address phone:** (925) 776-8386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | LTC60761F | CA | Yes |

## Other

- **Enumeration date:** 02/28/2007
- **Last updated:** 06/20/2008