MEDICARE: PENNI'S PLACE YOUTH HOME

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1639001548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNI'S PLACE YOUTH HOME

Provider Business Mailing Address
First Line	:	1412 ADAMS FARM PKWY APT R
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-5132
Country	:	US
Telephone Number	:	336-588-6119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 ADAMS FARM PKWY APT R
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-5132
Country	:	US
Telephone Number	:	336-588-6119
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	DANIELLE MONIQUE SYKES
Credential	:
Telephone Number	:	336-588-6119

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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