Provider Demographics
NPI:1699424085
Name:ONE PENNY LLC
Entity type:Organization
Organization Name:ONE PENNY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJDAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-754-3202
Mailing Address - Street 1:29450 SE LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-7429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29450 SE LARIAT LN
Practice Address - Street 2:
Practice Address - City:BORING
Practice Address - State:OR
Practice Address - Zip Code:97009-7429
Practice Address - Country:US
Practice Address - Phone:503-877-8342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health