Penick Village Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0127 Issued in NC

Legal business name

PENICK VILLAGE INC

Practice address

401 E Rhode Island Ave
Southern Pines, NC 28387-4009

Phone

(910) 692-0300

Fax

(910) 692-5509

NPI assigned

Aug 7, 2006

Last updated

Feb 16, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christopher Mooney

Title

Senior Director of Accounting

Phone

(910) 692-0434

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Episcopal Home for the Ageing in the Dioces of NC Former legal business name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780693663. Details of each certification follow.

• CCN 345111 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 345111

Legal name

PENICK VILLAGE, INC

Doing business as

PENICK VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Jan 1, 1974

Last certification

Jan 23, 2025

Beds

74 (32 certified)

Ownership / control type

Other Nonprofit

Organization structure

CorporationNon-profit

Incorporated

Feb 4, 1957 in NC

Enrollment address

401 E Rhode Island Ave
Southern Pines, NC 28387-4009

Nursing home name

PENICK VILLAGE

Listed as

Penick VillageCCN 345111 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

5 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

Jan 1, 1974

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

3223.7 residents per day on average

Penalties (3 years)

1Fines totaling $8,648

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• David E Hipp, MD

  • Internal Medicine Physician
  • Pinehurst, NC
  • NPI 1396789152

  Nursing home

  Care Compare affiliation
• William Miller Johnstone III, M.D.

  • Family Medicine Physician
  • Greenville, NC
  • NPI 1326433046

  Nursing home

  Care Compare affiliation
• Rajan Mitchell, D.O.

  • Family Medicine Physician
  • Randleman, NC
  • NPI 1881612687

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708041600000",
    "number": "1780693663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E RHODE ISLAND AVE",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874009",
            "telephone_number": "910-692-0300",
            "fax_number": "910-692-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E RHODE ISLAND AVE",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874009",
            "telephone_number": "910-692-0300",
            "fax_number": "910-692-5509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENICK VILLAGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "MOONEY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "SENIOR DIRECTOR OF ACCOUNTING",
        "authorized_official_telephone_number": "910-692-0434"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405111",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406353",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SKILLED NURSING",
            "identifier": "345111",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Episcopal Home for the Ageing in the Dioces of NC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jeannine Noble Pearson, PT, DPT
• Vance Alexander Pearson, PTA
• Lauren Peledge, FNP
• Rita Bianco Pena, COTA/L
• Victoria Pender, LMT
• Chelsea Perez
• Rachel Pessagno, OTR/L
• Peterkin & Associates, Inc.
• Petty Chiropractic, PLLC (Carolina Chiropractic)
• John Adam Petty, D.C.

• Skilled Nursing Facility in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.