Provider Demographics
NPI:1932979986
Name:AIYELABOLA, ORABELEMA (CEO)
Entity type:Individual
Prefix:MR
First Name:ORABELEMA
Middle Name:
Last Name:AIYELABOLA
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 PITTSTON CIR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1738
Mailing Address - Country:US
Mailing Address - Phone:667-304-8386
Mailing Address - Fax:
Practice Address - Street 1:164 PITTSTON CIR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1738
Practice Address - Country:US
Practice Address - Phone:667-304-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-01361374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide