Provider Demographics
NPI:1922480011
Name:CARELOG HEALTH SUPPORT SERVICES
Entity Type:Organization
Organization Name:CARELOG HEALTH SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER, OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:AYODEJI
Authorized Official - Middle Name:EGUAI
Authorized Official - Last Name:JEREMIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-653-2551
Mailing Address - Street 1:15835 FOOTHILL FARMS LOOP
Mailing Address - Street 2:APT 523
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3231
Mailing Address - Country:US
Mailing Address - Phone:512-252-0566
Mailing Address - Fax:
Practice Address - Street 1:15835 FOOTHILL FARMS LOOP
Practice Address - Street 2:APT 523
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3231
Practice Address - Country:US
Practice Address - Phone:512-252-0566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)