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General NPI Number Information
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NPI Number | 1114331758
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Entity Type | Individual
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Provider Name | ADETUNJI DAVIS ELETU
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Gender | Male
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 9400 STONEWALL RD APT A1
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City | MANASSAS
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State | VA
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Zip | 20110-5539
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Country | US
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Telephone | 571-505-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 9400 STONEWALL ROAD, #A1
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City | MANASSAS
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State | VA
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Zip | 20110
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Country | US
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Telephone | 571-505-0466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | S5103421
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License Number State | VA
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