=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841948478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L&A ABSOLUTE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2022
-----------------------------------------------------
Last Update Date | 03/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 UNION AVE STE 701
-----------------------------------------------------
City | IRVINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07111-3292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-849-6030
-----------------------------------------------------
Fax | 973-849-6365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 UNION AVE STE 701
-----------------------------------------------------
City | IRVINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07111-3292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-849-6030
-----------------------------------------------------
Fax | 973-849-6365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL ADMINISTRATION
-----------------------------------------------------
Name | DR. ADEBOLA SHERIFAT AJANAKU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-849-6030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------