Provider Demographics
NPI:1740756865
Name:ARIDEGBE, OLUFEMI OLAJIDE
Entity Type:Individual
Prefix:MR
First Name:OLUFEMI
Middle Name:OLAJIDE
Last Name:ARIDEGBE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:FEMI
Other - Middle Name:OLAJIDE
Other - Last Name:ARIDEGBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4509 MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5472
Mailing Address - Country:US
Mailing Address - Phone:325-305-3020
Mailing Address - Fax:
Practice Address - Street 1:4509 MARLBORO DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5472
Practice Address - Country:US
Practice Address - Phone:325-305-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances