Provider Demographics
NPI:1225637549
Name:EMMANUELFAVOR LLC
Entity Type:Organization
Organization Name:EMMANUELFAVOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RISIKAT
Authorized Official - Middle Name:OLASUMBO
Authorized Official - Last Name:OGUNYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-249-2584
Mailing Address - Street 1:14 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-1338
Mailing Address - Country:US
Mailing Address - Phone:908-249-2584
Mailing Address - Fax:
Practice Address - Street 1:14 LOWELL ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-1338
Practice Address - Country:US
Practice Address - Phone:908-249-2584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health