Provider Demographics
NPI:1073388104
Name:ADEWELL HOLISTIC HEALTH & MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:ADEWELL HOLISTIC HEALTH & MEDICAL CLINIC LLC
Other - Org Name:ADEWELL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP, PMHNP
Authorized Official - Prefix:DR
Authorized Official - First Name:ADERONKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHIBAJO
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:847-610-9400
Mailing Address - Street 1:103 NORWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-2239
Mailing Address - Country:US
Mailing Address - Phone:847-610-9400
Mailing Address - Fax:847-572-2170
Practice Address - Street 1:103 NORWOOD CT
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-2239
Practice Address - Country:US
Practice Address - Phone:224-425-8265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty