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Individual

SAMUEL OLUKUNLE OLUWOLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
102 OLIVIA CT, LA VERGNE, TN 37086-4504
(615) 732-3415
(615) 732-8954
Mailing address
102 OLIVIA CT, LA VERGNE, TN 37086-4504
(615) 732-3415
(615) 732-8954

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
253Z00000X
In Home Supportive Care Agency
Primary
376J00000X
Homemaker
TN
385H00000X
Respite Care
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
86-3482472
86-3482472
TN
Enumeration date
05/31/2022
Last updated
05/31/2022
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