Provider Demographics
NPI:1871136416
Name:PENIEL HOME CARE LLC
Entity type:Organization
Organization Name:PENIEL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COE/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-985-1209
Mailing Address - Street 1:5551 NW 125TH TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5551 NW 125TH TER
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3432
Practice Address - Country:US
Practice Address - Phone:866-473-6435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker