Provider Demographics
NPI:1649567132
Name:DEIFEOLU HERITAGE HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:DEIFEOLU HERITAGE HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FOLASHADE
Authorized Official - Middle Name:ADEOLA
Authorized Official - Last Name:FAGBAMIGBE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:817-705-6002
Mailing Address - Street 1:7207 FOSSIL HILL DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4448
Mailing Address - Country:US
Mailing Address - Phone:682-323-7728
Mailing Address - Fax:682-323-7728
Practice Address - Street 1:7207 FOSSIL HILL DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4448
Practice Address - Country:US
Practice Address - Phone:682-323-7728
Practice Address - Fax:682-323-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health