Provider Demographics
NPI:1093379083
Name:FADEYI, MOBEL
Entity Type:Individual
Prefix:
First Name:MOBEL
Middle Name:
Last Name:FADEYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALPHA
Other - Middle Name:HOST
Other - Last Name:HOME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4785 BISCAY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6820
Mailing Address - Country:US
Mailing Address - Phone:720-298-9114
Mailing Address - Fax:
Practice Address - Street 1:4785 BISCAY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6820
Practice Address - Country:US
Practice Address - Phone:720-298-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities