Healthcare Provider Details

I. General information

NPI: 1124931449
Provider Name (Legal Business Name): REHOBOTH SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 ARNOLD ST
PHILADELPHIA PA
19152-1825
US

IV. Provider business mailing address

1840 ARNOLD ST
PHILADELPHIA PA
19152-1825
US

V. Phone/Fax

Practice location:
  • Phone: 267-971-0646
  • Fax:
Mailing address:
  • Phone: 267-971-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ADEGBENGA ADEWOLE
Title or Position: OWNER
Credential:
Phone: 267-971-0646