Provider Demographics
NPI:1740340199
Name:ABIODUN AKINFENWA
Entity type:Organization
Organization Name:ABIODUN AKINFENWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINFENWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-571-5817
Mailing Address - Street 1:418 N MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3647
Mailing Address - Country:US
Mailing Address - Phone:817-571-5817
Mailing Address - Fax:817-571-9817
Practice Address - Street 1:418 N MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-3647
Practice Address - Country:US
Practice Address - Phone:817-571-5817
Practice Address - Fax:817-571-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health