Provider Demographics
NPI:1073119640
Name:ADEOYE, ADENIYI OLUBUNMI (OWNER)
Entity Type:Individual
Prefix:
First Name:ADENIYI
Middle Name:OLUBUNMI
Last Name:ADEOYE
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 PINO
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0108
Mailing Address - Country:US
Mailing Address - Phone:401-626-8800
Mailing Address - Fax:214-988-1301
Practice Address - Street 1:610 UPTOWN BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3527
Practice Address - Country:US
Practice Address - Phone:401-699-9989
Practice Address - Fax:214-988-1301
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX020255376K00000X, 374U00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion