Provider Demographics
NPI:1386052355
Name:ODEBODE, BABATUNDE
Entity type:Individual
Prefix:
First Name:BABATUNDE
Middle Name:
Last Name:ODEBODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 LIMERICK WAY
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5912
Mailing Address - Country:US
Mailing Address - Phone:240-354-7045
Mailing Address - Fax:
Practice Address - Street 1:608 LIMERICK WAY
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-5912
Practice Address - Country:US
Practice Address - Phone:240-354-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3581P163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR3581POtherRESIDENTIAL SERVICE AGENCY