PENICK VILLAGE INC
NPI 1780693663
Skilled Nursing Facility in Southern Pines, NC

Active since August 07, 2006CLIA 34D0862411 · Waiver
401 E RHODE ISLAND AVE, SOUTHERN PINES, NC 28387(910) 692-0300(910) 692-5509 Get Directions Write a Review

NPPES record last updated: February 16, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Penick Village Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENICK VILLAGE INC (NPI 1780693663), doing business as Episcopal Home For The Ageing In The Dioces Of Nc, is a healthcare organization registered as a skilled nursing facility in Southern Pines, North Carolina and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Christopher Mooney, Senior Director Of Accounting, as its authorized official.

NPPES Registry Identity

NPI1780693663
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NamePENICK VILLAGE INC
Location Address401 E RHODE ISLAND AVESouthern Pines, NC 28387-4009
Mailing Address401 E Rhode Island AveSouthern Pines, NC 28387-4009 · (910) 692-0300 · Fax (910) 692-5509
Fax(910) 692-5509
Organization SubpartNo
Authorized OfficialChristopher MooneySenior Director Of Accounting · (910) 692-0434
Enumeration DateAugust 7, 2006
Last NPPES UpdateFebruary 16, 2024
NPPES CertifiedFebruary 5, 2024
NPI 1780693663 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in NC · NH0127
Definition
(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.
401 E RHODE ISLAND AVE, Southern Pines, NC 28387

Other Names 1

Former Legal Business NameEpiscopal Home For The Ageing In The Dioces Of Nc

Other Identifiers 3

Medicaid3405111NC
Other345111NC · Medicare Skilled Nursing
Medicaid3406353NC

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D0862411

Penick Village, Inc · Southern Pines, NC
Active · expires Aug 31, 2026
CLIA Number34D0862411
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorJanell Reynolds
Laboratory Phone(910) 692-0300
Laboratory LocationPenick Village, Inc401 East Rhode Island Avenue, Southern Pines, NC 28387
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapy Assistant
401 E RHODE ISLAND AVE
SOUTHERN PINES, NC 28387

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Penick Village Inc's NPI number?

The NPI number for Penick Village Inc is 1780693663. It was assigned to this organization in the NPPES registry on August 7, 2006. The provider was formerly known as Episcopal Home For The Ageing In The Dioces Of Nc.

Where is Penick Village Inc located?

Penick Village Inc is located at 401 E Rhode Island Ave, Southern Pines, NC 28387. The listed phone number is (910) 692-0300.

What is Penick Village Inc's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Penick Village Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D0862411) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Penick Village Inc was last updated on February 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.