Provider Demographics
NPI:1972325165
Name:OMOLADE, ELIZABETH (DIRECTOR)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:OMOLADE
Suffix:
Gender:F
Credentials:DIRECTOR
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Mailing Address - Street 1:78 CHADDWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-8803
Mailing Address - Country:US
Mailing Address - Phone:267-575-8581
Mailing Address - Fax:
Practice Address - Street 1:14 E 40TH ST STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2361
Practice Address - Country:US
Practice Address - Phone:302-276-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DE2024927268376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker