Provider Demographics
NPI:1073842324
Name:OJIMADU, ISRAEL (CEO)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:OJIMADU
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7048 KNIGHTDALE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8894
Mailing Address - Country:US
Mailing Address - Phone:919-266-3591
Mailing Address - Fax:
Practice Address - Street 1:9200 SAYORNIS CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-8114
Practice Address - Country:US
Practice Address - Phone:919-247-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409683Medicaid