Provider Demographics
NPI:1598403289
Name:SEDARIDGE HOMECARE AND STAFFING LLC
Entity Type:Organization
Organization Name:SEDARIDGE HOMECARE AND STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:336-508-7724
Mailing Address - Street 1:5206 SILVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9289
Mailing Address - Country:US
Mailing Address - Phone:336-508-7724
Mailing Address - Fax:
Practice Address - Street 1:611 SUMMIT AVE STE 14
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7746
Practice Address - Country:US
Practice Address - Phone:336-508-7724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty