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General NPI Number Information
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NPI Number | 1871746297
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Entity Type | Organization
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Legal Business Name | ABAYOMI SAMUEL SOGE
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 579 OLDE CASTLE CT
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City | GALLOWAY
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State | OH
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Zip | 43119-9336
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Country | US
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Telephone | 614-202-9526
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Fax |
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Provider Business Mailing Address
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Address Line | 579 OLDE CASTLE CT
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City | GALLOWAY
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State | OH
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Zip | 43119-9336
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Country | US
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Telephone | 614-202-9526
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MR. ABAYOMI SAMUEL SOGE
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Credential |
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Telephone | 614-202-9526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | RN. 316469
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License Number State | OH
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