Peniel Interventional Care

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

PENIEL INTERVENTIONAL CARE

Doing business as

Peniel Interventional Care
Peniel Health Services

Practice address

318 Spry Island Rd
Joppa, MD 21085-5424

Phone

(317) 797-9816

NPI assigned

Jan 11, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elsie Antwiwaa Tweneboah-Koduah, FNP-BC

Title

Owner

Phone

(317) 797-9816

Specialties & licenses 1

Addresses

Other names 2

• PENIEL INTERVENTIONAL CARE Doing business as
• Peniel Health Services Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1871364646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 SPRY ISLAND RD",
            "city": "JOPPA",
            "state": "MD",
            "postal_code": "210855424",
            "telephone_number": "113-177-9798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 SPRY ISLAND RD",
            "city": "JOPPA",
            "state": "MD",
            "postal_code": "210855424",
            "telephone_number": "317-797-9816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENIEL INTERVENTIONAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "TWENEBOAH-KODUAH",
        "authorized_official_first_name": "ELSIE",
        "authorized_official_middle_name": "ANTWIWAA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-797-9816",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PENIEL INTERVENTIONAL CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peniel Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stella Okafor-Govina
• Uchenna A Osuwa, PHARM D
• Gitank Patel
• Jacqueline Lavelle Patel, DNP
• Patriot Psychiatric and Allied Health Services
• Peniel Interventional Care
• Jill Perez, LCSW-C
• Katelyn Nicole Peters, M.S. CF-SLP
• Jamie Pizza, M.S., CCC-SLP
• Pragmaly LLC Dba Pragmaly Healthcare

• Addiction Medicine (Family Medicine) Physician in Joppa, MD
• Providers in Joppa, MD by specialty
• Addiction Medicine (Family Medicine) Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.