Healthcare Provider Details

I. General information

NPI: 1366587578
Provider Name (Legal Business Name): INEZS HOUSE HC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 INDEPENDENCE AVE
DURHAM NC
27703
US

IV. Provider business mailing address

209 GANYARD FARM WAY
DURHAM NC
27703
US

V. Phone/Fax

Practice location:
  • Phone: 919-697-7340
  • Fax: 919-479-9055
Mailing address:
  • Phone: 919-697-7340
  • Fax: 919-479-9055

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 NumberMHL-032-356
License Number StateNC

VIII. Authorized Official

Name: MRS. HATTIE JOANN DUNHAM
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 919-697-7340