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General NPI Number Information
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NPI Number | 1942554027
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Entity Type | Individual
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Provider Name | OLABODE CHRISTOPHER ADEYEFA-OLASUPO CASE MANAGER
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Gender | Male
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 4660 MARTIN LUTHER KING JR AVE SW STE A2
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City | WASHINGTON
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State | DC
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Zip | 20032-4933
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Country | US
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Telephone | 202-318-0179
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Fax |
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Provider Business Mailing Address
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Address Line | 9540 RUBY LOCKHART BLVD APT 411
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City | BOWIE
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State | MD
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Zip | 20721-3426
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Country | US
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Telephone | 240-498-4098
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | DC
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