Provider Demographics
NPI:1003260357
Name:PENNYFARTHING LLC
Entity Type:Organization
Organization Name:PENNYFARTHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:208-255-1617
Mailing Address - Street 1:520 CEDAR ST
Mailing Address - Street 2:STE A
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1569
Mailing Address - Country:US
Mailing Address - Phone:208-255-1617
Mailing Address - Fax:
Practice Address - Street 1:520 CEDAR ST
Practice Address - Street 2:STE A
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1569
Practice Address - Country:US
Practice Address - Phone:208-255-1617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health