Provider Demographics
NPI:1427301829
Name:PENIEL MINISTRY
Entity type:Organization
Organization Name:PENIEL MINISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-536-2111
Mailing Address - Street 1:760 COOPER AVE
Mailing Address - Street 2:P. O. BOX 250
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-1033
Mailing Address - Country:US
Mailing Address - Phone:814-536-2111
Mailing Address - Fax:
Practice Address - Street 1:760 COOPER AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-1033
Practice Address - Country:US
Practice Address - Phone:814-536-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA117042324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility