=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275810939
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY TEES HOME HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2011
-----------------------------------------------------
Last Update Date | 11/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5454 CLEVELAND AVENUE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-568-0029
-----------------------------------------------------
Fax | 614-568-0029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5454 CLEVELAND AVENUE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-568-0029
-----------------------------------------------------
Fax | 614-568-0029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. OLATUNJI O. OBIKUNLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-940-9393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------