Individual provider Active NPI

Olusesan. A Fafiolu

  • In Home Supportive Care Agency
  • Harrisburg, PA
National Provider Identifier
1417767690
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
80673601 Issued in PA
Practice address
4811 Jonestown Rd Ste 226a
Harrisburg, PA 17109-1745
Phone
(717) 216-0083
Fax
(717) 216-0083
NPI assigned
Jan 10, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X 80673601 PA Primary

Addresses

Primary practice location

4811 Jonestown Rd Ste 226a
Harrisburg, PA 17109-1745

Mailing address

4811 Jonestown Rd Ste 226a
Harrisburg, PA 17109-1745
Phone (717) 216-0083

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
80673601PAMDIn Home Supportive Care Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Faffy Quality Home Care Services LLC In Home Supportive Care CurrentSince Jan 1, 2025 Accepting new patients

Locations

4811 Jonestown Rd
Ste 226A
Harrisburg, PA 17109
Phone (717) 216-0083

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1417767690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 JONESTOWN RD STE 226A",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171091745",
            "telephone_number": "717-216-0083",
            "fax_number": "717-216-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 JONESTOWN RD STE 226A",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171091745",
            "telephone_number": "717-216-0083",
            "fax_number": "717-216-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAFIOLU",
        "first_name": "OLUSESAN.",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-10",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "PA",
            "license": "80673601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.