Provider Demographics
NPI:1871746297
Name:ABAYOMI SAMUEL SOGE
Entity type:Organization
Organization Name:ABAYOMI SAMUEL SOGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:ABAYOMI
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:SOGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-202-9526
Mailing Address - Street 1:579 OLDE CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9336
Mailing Address - Country:US
Mailing Address - Phone:614-202-9526
Mailing Address - Fax:
Practice Address - Street 1:579 OLDE CASTLE CT
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9336
Practice Address - Country:US
Practice Address - Phone:614-202-9526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 316469313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility