Provider Demographics
NPI:1033931209
Name:PENIEL HOMECARE AGENCY
Entity type:Organization
Organization Name:PENIEL HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASUMADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-894-0975
Mailing Address - Street 1:101 BURBANK RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2806
Mailing Address - Country:US
Mailing Address - Phone:860-402-4857
Mailing Address - Fax:
Practice Address - Street 1:101 BURBANK RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2806
Practice Address - Country:US
Practice Address - Phone:860-894-0975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care