Healthcare Provider Details

I. General information

NPI: 1457953317
Provider Name (Legal Business Name): AHMED ABOLAJI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2020
Last Update Date: 11/14/2020
Certification Date: 11/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 FRANKLIN BLVD APT 104
CLEVELAND OH
44102-3101
US

IV. Provider business mailing address

6201 FRANKLIN BLVD APT 104
CLEVELAND OH
44102-3101
US

V. Phone/Fax

Practice location:
  • Phone: 216-456-6524
  • Fax:
Mailing address:
  • Phone: 216-456-6524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number1830102
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1830102
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1830102
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: