Samuel Olukunle Oluwole

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Practice address

102 Olivia CT
La Vergne, TN 37086-4504

Phone

(615) 732-3415

Fax

(615) 732-8954

NPI assigned

May 31, 2022

Sex

Male

Sole proprietor

Yes

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.

• Mountzion Community Supports LLC

  • In Home Supportive Care Agency
  • Nashville, TN
  • NPI 1417655887

  In Home Supportive Care

  NPD Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 31, 2022.

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1811636616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 OLIVIA CT",
            "city": "LA VERGNE",
            "state": "TN",
            "postal_code": "370864504",
            "telephone_number": "615-732-3415",
            "fax_number": "615-732-8954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 OLIVIA CT",
            "city": "LA VERGNE",
            "state": "TN",
            "postal_code": "370864504",
            "telephone_number": "615-732-3415",
            "fax_number": "615-732-8954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUWOLE",
        "first_name": "SAMUEL",
        "middle_name": "OLUKUNLE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-31",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "86-3482472",
            "identifier": "86-3482472",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in La Vergne, TN
• In Home Supportive Care Agency in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; 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.