Provider Demographics
NPI:1366703035
Name:ROSS, ADEBOLA (HHA)
Entity type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HARRY S TRUMAN DR APT 23
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2055
Mailing Address - Country:US
Mailing Address - Phone:860-422-3986
Mailing Address - Fax:
Practice Address - Street 1:205 HARRY S TRUMAN DR APT 23
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2055
Practice Address - Country:US
Practice Address - Phone:860-422-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide