Provider Demographics
NPI:1316412620
Name:ARIDEGBE, OLAJUMOKE OLAYINKA I
Entity Type:Individual
Prefix:MISS
First Name:OLAJUMOKE
Middle Name:OLAYINKA
Last Name:ARIDEGBE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 S CLACK ST APT 245
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1449
Mailing Address - Country:US
Mailing Address - Phone:301-377-4847
Mailing Address - Fax:
Practice Address - Street 1:2016 S CLACK ST APT 245
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1449
Practice Address - Country:US
Practice Address - Phone:301-377-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances