Provider Demographics
NPI:1841420577
Name:THEO ADEOYE
Entity Type:Organization
Organization Name:THEO ADEOYE
Other - Org Name:PARADISE HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOYE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:817-368-4524
Mailing Address - Street 1:917 HEMS LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5922
Mailing Address - Country:US
Mailing Address - Phone:817-368-4524
Mailing Address - Fax:817-468-0735
Practice Address - Street 1:917 HEMS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-5922
Practice Address - Country:US
Practice Address - Phone:817-368-4524
Practice Address - Fax:817-468-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011345314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011345OtherSTATE LICENSE NUMBER