=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992463772
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSURANCE CARE NURSING HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2021
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31515 RANCHO PUEBLO RD STE 102
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92592-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-885-4088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30724 BENTON RD STE C302
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92596-8470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-316-4353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. TOLULOPE TITILAYO ADEDAYO
-----------------------------------------------------
Credential | DNP, MSN, FNP-C, PMH
-----------------------------------------------------
Telephone | 951-777-0788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------