Peniel House, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

PENIEL HOUSE, LLC

Practice address

724 Yorkshire Dr
Clayton, NC 27520-2973

Phone

(919) 436-8298

NPI assigned

Jan 16, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Latashia Edwards

Title

Executive Director

Phone

(919) 436-8298

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484524800000",
    "number": "1700322765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 STEEL HOPPER WAY",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275297358",
            "telephone_number": "919-436-8298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 YORKSHIRE DR",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275202973",
            "telephone_number": "919-436-8298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENIEL HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-16",
        "last_updated": "2017-01-16",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "LATASHIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-436-8298",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Austin Porter Patrick, DO
• Sharon Payne, OTRL
• Pediatric Possibilities
• Maria Pena
• Marissa Pender, RDN, LDN
• Lave Wilson Pennywell
• People Living in All Communities
• Joan Yolanda Perez
• Cameron Luther Perkins, PA
• Jennifer Lynn Petrone, PA-C

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Clayton, NC
• Providers in Clayton, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.