MEDICARE: PENUEL LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1356230353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENUEL LLC

Provider Business Mailing Address
First Line	:	183 BEECHMONT DR
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-2541
Country	:	US
Telephone Number	:	443-985-5667
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 BEECHMONT DR
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-2541
Country	:	US
Telephone Number	:	443-857-1875
Fax Number	:

Authorized Official
Title or Position	:	DEPUTY DIRECTOR
Name	:	OLUWAFEMI A OJEKUNLE
Credential	:
Telephone Number	:	443-985-5667

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	03/04/2026

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Directions to “PENUEL LLC ” Practice Location

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