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General NPI Number Information
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NPI Number | 1235377540
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Entity Type | Organization
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Legal Business Name | MIKE A.OGUNKAH
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 14719 HAWTHORNE BLVD STE 202 SUITE 202
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City | LAWNDALE
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State | CA
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Zip | 90260-1544
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Country | US
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Telephone | 310-219-2889
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Fax | 310-219-2891
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Provider Business Mailing Address
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Address Line | 14719 HAWTHORNE BLVD STE 202 SUITE 202
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City | LAWNDALE
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State | CA
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Zip | 90260-1544
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Country | US
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Telephone | 310-219-2889
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Fax | 310-219-2891
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL OGUNKAH
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Credential | MBA
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Telephone | 310-219-2889
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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 | 550000178
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License Number State | CA
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