Provider Demographics
NPI:1083452221
Name:PENIEL HEALTHCARE DBA PENIEL HOMECARE
Entity type:Organization
Organization Name:PENIEL HEALTHCARE DBA PENIEL HOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:POKUA
Authorized Official - Last Name:ADU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTIONER
Authorized Official - Phone:804-714-9625
Mailing Address - Street 1:5704 RODEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-7874
Mailing Address - Country:US
Mailing Address - Phone:804-714-9625
Mailing Address - Fax:
Practice Address - Street 1:5704 RODEN PARK DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-7874
Practice Address - Country:US
Practice Address - Phone:804-714-9625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty