Active NPI
Adeleke Ijiyode
- In Home Supportive Care Agency
- Spring Lake Park, MN
National Provider Identifier
1720627490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Home Supportive Care Agency
- License
- 394860
- Practice address
- 556 84TH Ave NE
Spring Lake Park, MN 55432-1141 - Phone
- (612) 222-1829
- NPI assigned
- Dec 30, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | 394860 | MN | Primary |
Addresses
Primary practice location
556 84TH Ave NE
Spring Lake Park, MN 55432-1141
Mailing address
556 84TH Ave NE
Spring Lake Park, MN 55432-1141
Phone (612) 222-1829
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
| License | State | Type | Specialty |
|---|---|---|---|
| 394860 | MN | MD | In Home Supportive Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577664000000",
"number": "1720627490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "556 84TH AVE NE",
"city": "SPRING LAKE PARK",
"state": "MN",
"postal_code": "554321141",
"telephone_number": "612-222-1829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "556 84TH AVE NE",
"city": "SPRING LAKE PARK",
"state": "MN",
"postal_code": "554321141",
"telephone_number": "612-222-1829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IJIYODE",
"first_name": "ADELEKE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-12-30",
"last_updated": "2019-12-30",
"certification_date": "2019-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": "MN",
"license": "394860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spring Lake Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.