PENICK VILLAGE INC (NPI# 1780693663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780693663 |
| Entity Type | Organization |
| Organization Name | PENICK VILLAGE INC |
| Other Organization Name | EPISCOPAL HOME FOR THE AGEING IN THE DIOCES OF NC |
| Practice Address |
500 E Rhode Island Ave Southern Pines NC 28387-4010 |
| Practice Telephone | 9106920300 |
| Practice Fax Number | 9106925509 |
| Mailing Telephone | 9106920300 |
| Mailing Fax Number | 9106925509 |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2016-04-08 |
| Authorized Official Name | MRS. TAMARA C FORE (CONTROLLER) |
| Authorized Official Telephone | 9106920432 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | NH0127 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 3405111 | 05 | |
| NC | 3406353 | 05 | |
| NC | MEDICARE SKILLED NURSING | 345111 | 01 |
| Other Name | Type Code |
|---|---|
| Episcopal Home for the Ageing in the Dioces of NC | Former Legal Business Name - Organization |
| Street Address |
500 E RHODE ISLAND AVE |
| City | SOUTHERN PINES |
| State | NC |
| Zip Code | 28387-4010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750939708 | Kristen Renee Gutman | Occupational Therapist | 500 E Rhode Island Ave, Southern Pines, NC 28387-4010 | 2019-09-03 |
| 1437701638 | Allie Newton | Occupational Therapist | 500 E Rhode Island Ave, Southern Pines, NC 28387-4010 | 2019-07-09 |
| 1285115071 | Thomas Christensen | Speech-Language Pathologist | 500 E Rhode Island Ave, Southern Pines, NC 28387-4010 | 2018-08-28 |
| 1023598703 | Caroline Goforth Carlson | Physical Therapist | 500 E Rhode Island Ave, Southern Pines, NC 28387-4010 | 2018-08-21 |
| 1134518897 | Yolanda Bynum | Physical Therapy Assistant | 500 E Rhode Island Ave, Southern Pines, NC 28387-4010 | 2015-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861972028 | Wright and Associates X Dds Pa | Dentist | 10677 Nc Hwy 15-501, Southern Pines, NC 28387 | 2018-08-17 |
| 1821507294 | Brooke Ashley Thomas | Physical Therapist | 275 Pinehurst Ave Suite B, Southern Pines, NC 28387 | 2017-09-28 |
| 1497208987 | Laura Permelia Jackson | Specialist/Technologist | 3300 Airport Road, Southern Pines, NC 28387 | 2016-08-01 |
| 1164860417 | Monarch | Community/Behavioral Health | 1662 Richards St, Southern Pines, NC 28387 | 2013-06-10 |
| 1619313202 | Nicole Jacobs | Psychiatry & Neurology | 195 West Illinois Avenue, Attn: April Smith, Southern Pines, NC 28387 | 2013-05-22 |
| 1932458395 | Heather N Dunning | Social Worker | 230 Murray Hill Rd, Southern Pines, NC 28387 | 2012-08-31 |
| 1487948451 | Hugh Perry Gayman Jr. | Physical Therapist | 103 Gossman Dr, Southern Pines, NC 28387 | 2011-06-07 |
| 1083919245 | John Adam Petty | Chiropractor | 1295 Old Us 1, Suite F, Southern Pines, NC 28387 | 2011-01-20 |
| 1962704775 | Specialty Pharmacy-southern Pines LLC | Pharmacy | 735 S. Bennett St., Southern Pines, NC 28387 | 2010-11-30 |
| 1922317080 | At Home Senior Services, Inc. | Home Health | 340 Commerce Avenue, Suite 14-a Yadkin Plaza, Southern Pines, NC 28387 | 2010-10-06 |
| Find all providers in zip 28387 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184712580 | St. Joseph of The Pines, Inc | Skilled Nursing Facility | 103 Gossman Rd, Southern Pines, NC 28387-2225 | 2006-10-11 |
| 1700229341 | Christopher J Mccoy | Skilled Nursing Facility | 103 Gossman Rd, Southern Pines, NC 28387-2225 | 2013-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164063756 | Cary Senior Housing I Opco, LLC | Skilled Nursing Facility | 221 Brightmore Dr, Cary, NC 27518-8145 | 2019-10-04 |
| 1629535455 | Liberty Healthcare Group, LLC | Skilled Nursing Facility | 621 Chestnut Ridge Pkwy, Blowing Rock, NC 28605-8962 | 2019-02-28 |
| 1871063214 | Vero Health X, LLC | Skilled Nursing Facility | 417 Cloverdale Rd, Sylva, NC 28779-0679 | 2018-11-28 |
| 1821573809 | Carolina Bay Healthcare Center of Wilmington, LLC | Skilled Nursing Facility | 740 Diamond Shoals Rd, Wilmington, NC 28403-4388 | 2018-09-26 |
| 1093228397 | Bellarose Nursing and Rehab Center, Inc. | Skilled Nursing Facility | 200 Bellarose Lake Way, Garner, NC 27529-7049 | 2017-11-08 |
| 1558872333 | Brunswick Health & Rehab Center, LLC | Skilled Nursing Facility | 9600 No 5 School Rd Nw, Ash, NC 28420-2122 | 2017-10-19 |
| 1538684212 | Eagle Acquisition Vi LLC | Skilled Nursing Facility | 901 S Halstead Blvd., Elizabeth City, NC 27909-6920 | 2017-08-03 |
| 1982130811 | Ashton Health and Rehabilitation, LLC | Skilled Nursing Facility | 5533 Burlington Rd, Mc Leansville, NC 27301-9622 | 2017-05-11 |
| 1831625037 | Supplemental Healthcare | Skilled Nursing Facility | 319 Vancouver Drive, Apartment 38g, Fayetteville, NC 28303 | 2017-05-08 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHERN PINES |
| Zip Code | 28387 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.