Provider Demographics
NPI:1821705591
Name:ADIGUN, ADEKUNLE (ASSISTED LIVING)
Entity Type:Individual
Prefix:MR
First Name:ADEKUNLE
Middle Name:
Last Name:ADIGUN
Suffix:
Gender:M
Credentials:ASSISTED LIVING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2709
Mailing Address - Country:US
Mailing Address - Phone:651-319-0140
Mailing Address - Fax:651-319-0140
Practice Address - Street 1:208 14TH ST W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2709
Practice Address - Country:US
Practice Address - Phone:651-319-0140
Practice Address - Fax:651-319-0140
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN409681310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility