=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760807242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SONIADE CARES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2014
-----------------------------------------------------
Last Update Date | 09/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5930 HOHMAN AVE ,SUITE211
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46320-3050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-937-6044
-----------------------------------------------------
Fax | 219-937-6103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5930 HOHMAN AVENUE, SUITE211 HARRISON PARK CENTRE
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-937-6044
-----------------------------------------------------
Fax | 219-937-6103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AKPEVWE SONIA ADEMIJU
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 219-937-6044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 140133551
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------