Provider Demographics
NPI:1720682578
Name:IKENEKU, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:IKENEKU
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 1:3232 BAFFIN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-7833
Mailing Address - Country:US
Mailing Address - Phone:513-253-3876
Mailing Address - Fax:
Practice Address - Street 1:3232 BAFFIN DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-7833
Practice Address - Country:US
Practice Address - Phone:513-253-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child