Provider Demographics
NPI:1508632654
Name:SEGBOL CAREGIVER LLC
Entity Type:Organization
Organization Name:SEGBOL CAREGIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNJIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-548-7700
Mailing Address - Street 1:9757 MOUNTAIN LAUREL WAY APT 3A
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6331
Mailing Address - Country:US
Mailing Address - Phone:240-548-7700
Mailing Address - Fax:
Practice Address - Street 1:9757 MOUNTAIN LAUREL WAY APT 3A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-6331
Practice Address - Country:US
Practice Address - Phone:240-548-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care