Provider Demographics
NPI:1013392851
Name:PENIEL 2 GROUP HOME
Entity Type:Organization
Organization Name:PENIEL 2 GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-859-0259
Mailing Address - Street 1:20 JERVEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-0017
Mailing Address - Country:US
Mailing Address - Phone:828-859-0259
Mailing Address - Fax:
Practice Address - Street 1:2960 PENIEL RD
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-8807
Practice Address - Country:US
Practice Address - Phone:828-859-0259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNERGY IN ACTION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-22
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care