34D0862411 CLIA NUMBER - PENICK VILLAGE, INC

Laboratory Demographics

  • CLIA Code: 34D0862411
  • Facility Name: PENICK VILLAGE, INC
  • Facility Address: 401 EAST RHODE ISLAND AVENUE
    SOUTHERN PINES, NC
    ZIP 28387
  • Facility Phone: 910 692-0300
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JANELL REYNOLDS
  • NPI Number: 1780693663
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D0862411
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PENICK VILLAGE, INC
Street 401 EAST RHODE ISLAND AVENUE
City SOUTHERN PINES
State NC
ZIP 28387
Phone 910 692-0300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JANELL REYNOLDS

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This page was last updated on: 9/29/2025