Organization
PENIEL HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATASHIA EDWARDS (EXECUTIVE DIRECTOR)
(919) 436-8298
Entity
Organization
Contact information
Practice address
724 YORKSHIRE DR, CLAYTON, NC 27520-2973
(919) 436-8298
Mailing address
201 STEEL HOPPER WAY, GARNER, NC 27529-7358
(919) 436-8298
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/16/2017
Last updated
01/16/2017
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