=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376481010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENDRICS PLACE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2026
-----------------------------------------------------
Last Update Date | 03/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1422 CARNSMORE DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-2991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-404-0995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1422 CARNSMORE DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-2991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-404-0995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. NNAMDI MCDOWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-404-0995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 373H00000X
-----------------------------------------------------
Taxonomy Name | Day Training/Habilitation Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------