MEDICARE: ACCESS HEALTH SYSTEM 1, CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205048766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS HEALTH SYSTEM 1, CORP

Provider Business Mailing Address
First Line	:	5132 DICE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-5655
Country	:	US
Telephone Number	:	919-747-9514
Fax Number	:	919-341-0486

Provider Business Practice Location Address
First Line	:	5132 DICE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-5655
Country	:	US
Telephone Number	:	919-747-9514
Fax Number	:	919-341-0486

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	GLORIA OGUGUA ILONZE
Credential	:	RN, BSN
Telephone Number	:	919-349-3807

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/21/2023

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