Healthcare Provider Details

I. General information

NPI: 1417217001
Provider Name (Legal Business Name): ADELOYE GBADEGESIN HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 DUTCH VILLAGE DR
LANDOVER MD
20785-4169
US

IV. Provider business mailing address

1767 DUTCH VILLAGE DR
LANDOVER MD
20785-4169
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-0935
  • Fax:
Mailing address:
  • Phone: 202-545-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA0719
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: