Healthcare Provider Details

I. General information

NPI: 1316208770
Provider Name (Legal Business Name): ADEBOLA ADEWALE OLUDASI HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 75TH AVE APT 201
LANDOVER MD
20785-1922
US

IV. Provider business mailing address

3151 ROLAND KENNER LOOP APT 303
GLENARDEN MD
20706-2725
US

V. Phone/Fax

Practice location:
  • Phone: 301-257-4275
  • Fax:
Mailing address:
  • Phone: 301-257-4275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1059680
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP50856
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN1007593
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: