Healthcare Provider Details

I. General information

NPI: 1407014962
Provider Name (Legal Business Name): ANGEL START OF DURHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N DUKE ST SUITE 103
DURHAM NC
27704-1709
US

IV. Provider business mailing address

3600 N DUKE ST SUITE 103
DURHAM NC
27704-1709
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-1800
  • Fax: 919-471-1877
Mailing address:
  • Phone: 919-471-1800
  • Fax: 919-471-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC1308
License Number StateNC

VIII. Authorized Official

Name: VERONICA MCCLENDON
Title or Position: VICE PRESIDENT
Credential:
Phone: 704-549-1659