Healthcare Provider Details

I. General information

NPI: 1972993343
Provider Name (Legal Business Name): RAYNI ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SOUTHFORK VILLAGE DR APT 203
BELMONT NC
28012-7829
US

IV. Provider business mailing address

1030 SOUTHFORK VILLAGE DR APT 203
BELMONT NC
28012-7829
US

V. Phone/Fax

Practice location:
  • Phone: 704-492-1631
  • Fax:
Mailing address:
  • Phone: 704-492-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ADEDAYO WEBB
Title or Position: OWNER
Credential:
Phone: 704-492-1631