Provider Demographics
NPI:1700083656
Name:ADEOLA MUSTAPHA
Entity Type:Organization
Organization Name:ADEOLA MUSTAPHA
Other - Org Name:THE COMFORTER HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASS. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BOLANLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUSTAPHA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-213-5464
Mailing Address - Street 1:3352 SEDONA DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8401
Mailing Address - Country:US
Mailing Address - Phone:972-522-0836
Mailing Address - Fax:972-522-0834
Practice Address - Street 1:3352 SEDONA DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8401
Practice Address - Country:US
Practice Address - Phone:972-522-0836
Practice Address - Fax:972-522-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010765251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health