Provider Demographics
NPI:1982202594
Name:OLUGUS FAMILY CARE
Entity Type:Organization
Organization Name:OLUGUS FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:KEAUNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLUGU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-474-3054
Mailing Address - Street 1:44077 W. PALMEN DR.
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138
Mailing Address - Country:US
Mailing Address - Phone:405-474-3054
Mailing Address - Fax:
Practice Address - Street 1:44077 W. PALMEN DR.
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138
Practice Address - Country:US
Practice Address - Phone:405-474-3054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty