Provider Demographics
NPI:1407646888
Name:NISSI INTEGRATED LLC
Entity type:Organization
Organization Name:NISSI INTEGRATED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:O
Authorized Official - Last Name:OYELAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-905-0962
Mailing Address - Street 1:25 KING AVE
Mailing Address - Street 2:
Mailing Address - City:FOLCROFT
Mailing Address - State:PA
Mailing Address - Zip Code:19032-1023
Mailing Address - Country:US
Mailing Address - Phone:610-905-0962
Mailing Address - Fax:
Practice Address - Street 1:621 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1506
Practice Address - Country:US
Practice Address - Phone:610-905-4106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care