Provider Demographics
NPI:1801300454
Name:OUR EMMANUEL LNC
Entity type:Organization
Organization Name:OUR EMMANUEL LNC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLADAPO
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ADEYALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-699-3344
Mailing Address - Street 1:1411 H ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5034
Mailing Address - Country:US
Mailing Address - Phone:301-699-3344
Mailing Address - Fax:240-487-6103
Practice Address - Street 1:5639 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2212
Practice Address - Country:US
Practice Address - Phone:301-699-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-18
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care