Healthcare Provider Details

I. General information

NPI: 1083452221
Provider Name (Legal Business Name): PENIEL HEALTHCARE DBA PENIEL HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MACK RD STE 350
FAIRFIELD OH
45014-5392
US

IV. Provider business mailing address

3050 MACK RD STE 350
FAIRFIELD OH
45014-5392
US

V. Phone/Fax

Practice location:
  • Phone: 804-714-9625
  • Fax:
Mailing address:
  • Phone: 513-393-5166
  • Fax: 513-808-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. EUNICE POKUA ADU
Title or Position: PMHNP
Credential: NURSE PRACTIONER
Phone: 513-393-5166