Provider Demographics
NPI:1770014268
Name:PELUMI BADMUS INS. AGENCY, LLC
Entity Type:Organization
Organization Name:PELUMI BADMUS INS. AGENCY, LLC
Other - Org Name:VOGUE ASSURANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLUWAPELUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUKOTUN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MSHA, APRN, CCM
Authorized Official - Phone:571-400-8461
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS REY
Mailing Address - State:CA
Mailing Address - Zip Code:92068-0558
Mailing Address - Country:US
Mailing Address - Phone:571-400-8461
Mailing Address - Fax:
Practice Address - Street 1:155 L STREET, NW
Practice Address - Street 2:( R.H TERRELL RECREATION CENTER)
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001
Practice Address - Country:US
Practice Address - Phone:571-400-8461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERO'S SHELTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-25
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4217575251300000X, 251B00000X, 251T00000X, 252Y00000X, 305S00000X, 332B00000X, 347C00000X, 251T00000X
251E00000X, 251X00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No305S00000XManaged Care OrganizationsPoint of Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE999999999999Medicaid
CO999999999999Medicaid
AL999999999999Medicaid
NY999999999999Medicaid
LA999999999999Medicaid
GA999999999999Medicaid
TX999999999999Medicaid
CA999999999999Medicaid
FL999999999999Medicaid
VA999999999999Medicaid
NC999999999999Medicaid
DC999999999999Medicaid
MD999999999999Medicaid