# PENICK VILLAGE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Episcopal Home for the Ageing in the Dioces of NC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780693663
- **Authorized official:** CHRISTOPHER MOONEY (SENIOR DIRECTOR OF ACCOUNTING)
- **Authorized official phone:** (910) 692-0434

## Contact information

- **Practice address:** 401 E RHODE ISLAND AVE, SOUTHERN PINES, NC 28387-4009
- **Practice address phone:** (910) 692-0300
- **Practice address fax:** (910) 692-5509
- **Mailing address:** 401 E RHODE ISLAND AVE, SOUTHERN PINES, NC 28387-4009
- **Mailing address phone:** (910) 692-0300
- **Mailing address fax:** (910) 692-5509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0127 | NC | Yes |

## Other

- **Enumeration date:** 08/07/2006
- **Last updated:** 02/16/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3405111 | — | NC |
| 05 | — | 3406353 | — | NC |
| 01 | — | 345111 | MEDICARE SKILLED NURSING | NC |