MEDICARE: KENDRICS PLACE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1376481010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDRICS PLACE LLC

Provider Business Mailing Address
First Line	:	1422 CARNSMORE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-2991
Country	:	US
Telephone Number	:	864-404-0995
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 CARNSMORE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-2991
Country	:	US
Telephone Number	:	864-404-0995
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. NNAMDI MCDOWELL
Credential	:
Telephone Number	:	864-404-0995

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “KENDRICS PLACE LLC ” Practice Location

Language	Start Address	Practice Location

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