Healthcare Provider Details

I. General information

NPI: 1396242061
Provider Name (Legal Business Name): ADESOJI OPEMIPO AIYETAN I HOME HEALTH AIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 BUNKER HILL RD NE
WASHINGTON DC
20017-3026
US

IV. Provider business mailing address

1731 BUNKER HILL RD NE
WASHINGTON DC
20017-3026
US

V. Phone/Fax

Practice location:
  • Phone: 202-635-5756
  • Fax: 202-635-5780
Mailing address:
  • Phone: 202-635-5756
  • Fax: 202-635-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13503
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA13503
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: