Provider Demographics
NPI:1063193423
Name:ILE OLODUMARE IFE IFA
Entity type:Organization
Organization Name:ILE OLODUMARE IFE IFA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVEREND, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-645-6886
Mailing Address - Street 1:100 CO OP CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3800
Mailing Address - Country:US
Mailing Address - Phone:917-645-6886
Mailing Address - Fax:
Practice Address - Street 1:100 CO OP CITY BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3800
Practice Address - Country:US
Practice Address - Phone:917-645-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty