Healthcare Provider Details

I. General information

NPI: 1003215195
Provider Name (Legal Business Name): DURHAM CENTER FOR SENIOR LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 RIGSBEE AVE SUITE 202
DURHAM NC
27701-2186
US

IV. Provider business mailing address

406 RIGSBEE AVE SUITE 202
DURHAM NC
27701-2186
US

V. Phone/Fax

Practice location:
  • Phone: 919-688-8247
  • Fax: 919-683-3406
Mailing address:
  • Phone: 919-688-8247
  • Fax: 919-683-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number000615
License Number StateNC

VIII. Authorized Official

Name: SEANYEA RAINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-688-8247