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General NPI Number Information
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NPI Number | 1740001825
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Entity Type | Individual
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Provider Name | OLUFEMI ADEBAYO HOME CARE PROVIDER
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Gender | Male
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 222 N MOUNTAIN AVE STE 210A
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City | UPLAND
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State | CA
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Zip | 91786-5714
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Country | US
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Telephone | 626-252-5674
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Fax |
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Provider Business Mailing Address
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Address Line | 15824 SNOWY PEAK LANE, FONTANA, CA 92336 222 N. MOUNTAIN AVE, SUITE 210-A
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 626-252-5674
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 00008224
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License Number State | CA
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