MEDICARE: MRS. CAROLINE YEJIDE BABALOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	13106	DC

General Provider Information

NPI Number	:	1184134959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINE YEJIDE BABALOLA

Provider Business Mailing Address
First Line	:	11215 OAK LEAF DR APT C-1415
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1317
Country	:	US
Telephone Number	:	202-820-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	4809 GEORGIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4533
Country	:	US
Telephone Number	:	202-291-0717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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