Provider Demographics
NPI:1508429242
Name:ADELEKE, ADEWOLE ISAIAH
Entity type:Individual
Prefix:
First Name:ADEWOLE
Middle Name:ISAIAH
Last Name:ADELEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 BOB O LINK RD
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1420
Mailing Address - Country:US
Mailing Address - Phone:708-351-9137
Mailing Address - Fax:
Practice Address - Street 1:18041 THOMAS LN
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5065
Practice Address - Country:US
Practice Address - Phone:708-914-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities