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Organization
PENICK VILLAGE INC
Active
Organization
PENICK VILLAGE INC
Active
Other names
Episcopal Home for the Ageing in the Dioces of NC
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER MOONEY (SENIOR DIRECTOR OF ACCOUNTING)
(910) 692-0434
Entity
Organization
Contact information
Practice address
401 E RHODE ISLAND AVE, SOUTHERN PINES, NC 28387-4009
(910) 692-0300
(910) 692-5509
Mailing address
401 E RHODE ISLAND AVE, SOUTHERN PINES, NC 28387-4009
(910) 692-0300
(910) 692-5509
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0127
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3405111
—
NC
05
—
3406353
—
NC
01
—
345111
MEDICARE SKILLED NURSING
NC
Enumeration date
08/07/2006
Last updated
02/16/2024
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