Provider Demographics
NPI:1609078575
Name:BOLADEMI ADETOLA
Entity Type:Organization
Organization Name:BOLADEMI ADETOLA
Other - Org Name:LIFECARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTORDPCS
Authorized Official - Prefix:
Authorized Official - First Name:BOLADEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:310-539-6889
Mailing Address - Street 1:24404 VERMONT AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2313
Mailing Address - Country:US
Mailing Address - Phone:310-539-6889
Mailing Address - Fax:310-517-0171
Practice Address - Street 1:24404 VERMONT AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2313
Practice Address - Country:US
Practice Address - Phone:310-539-6889
Practice Address - Fax:310-517-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health