Healthcare Provider Details

I. General information

NPI: 1083454250
Provider Name (Legal Business Name): ADJUVANT HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 ASSOCIATION DR # 513
RESTON VA
20191-1500
US

IV. Provider business mailing address

1034 EAST ST APT 3307
WALPOLE MA
02081-3037
US

V. Phone/Fax

Practice location:
  • Phone: 571-600-1015
  • Fax:
Mailing address:
  • Phone: 301-404-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL AYODEJI ILESANMI
Title or Position: MANAGING PARTNER
Credential:
Phone: 571-600-1015