Provider Demographics
NPI:1982074407
Name:PHEMADEX HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:PHEMADEX HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-843-5897
Mailing Address - Street 1:830 ASHLAND PARK WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6808
Mailing Address - Country:US
Mailing Address - Phone:770-843-5897
Mailing Address - Fax:770-544-7074
Practice Address - Street 1:830 ASHLAND PARK WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6808
Practice Address - Country:US
Practice Address - Phone:770-843-5897
Practice Address - Fax:770-544-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067R1324251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health