Provider Demographics
NPI:1386798205
Name:ADONAI HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:ADONAI HOME HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:J
Authorized Official - Middle Name:SUKKY
Authorized Official - Last Name:FAGBOHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-398-2456
Mailing Address - Street 1:1832 SNAKE RIVER ROAD, SUITE A
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449
Mailing Address - Country:US
Mailing Address - Phone:281-398-2456
Mailing Address - Fax:
Practice Address - Street 1:1832 SNAKE RIVER ROAD, SUITE A
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449
Practice Address - Country:US
Practice Address - Phone:281-398-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011080251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679753Medicare Oscar/Certification