Provider Demographics
NPI:1083454250
Name:ADJUVANT HOME HEALTH LLC
Entity type:Organization
Organization Name:ADJUVANT HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:AYODEJI
Authorized Official - Last Name:ILESANMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-404-4125
Mailing Address - Street 1:1034 EAST ST APT 3307
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3037
Mailing Address - Country:US
Mailing Address - Phone:301-404-4125
Mailing Address - Fax:
Practice Address - Street 1:6668 COLONNADES DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187-9333
Practice Address - Country:US
Practice Address - Phone:571-600-1015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health