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General NPI Number Information
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NPI Number | 1275326894
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Entity Type | Individual
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Provider Name | PENNEL ADDY
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 613 POPLAR DR
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City | SHELBY
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State | NC
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Zip | 28152-7619
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Country | US
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Telephone | 980-258-3094
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Fax |
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Provider Business Mailing Address
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Address Line | 3229 LIBERTY ELM LN
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City | GASTONIA
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State | NC
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Zip | 28056-5227
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Country | US
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Telephone | 802-583-0949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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