Provider Demographics
NPI:1538520804
Name:FOUNDING FATHERS ELDERLY CARE
Entity type:Organization
Organization Name:FOUNDING FATHERS ELDERLY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:202-785-2577
Mailing Address - Street 1:2808 MOORES PLAINS BLVD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8057
Mailing Address - Country:US
Mailing Address - Phone:301-326-5867
Mailing Address - Fax:301-627-3968
Practice Address - Street 1:2808 MOORES PLAINS BLVD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8057
Practice Address - Country:US
Practice Address - Phone:301-326-5867
Practice Address - Fax:301-627-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1009677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
393605Medicare PIN