Healthcare Provider Details

I. General information

NPI: 1376797647
Provider Name (Legal Business Name): MR. RAYMOND EARL BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DINEZ BAKER

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LAMON ST STE 108
FAYETTEVILLE NC
28301-4962
US

IV. Provider business mailing address

111 LAMON ST STE 108
FAYETTEVILLE NC
28301-4962
US

V. Phone/Fax

Practice location:
  • Phone: 910-412-0196
  • Fax: 472-300-1296
Mailing address:
  • Phone: 910-689-7658
  • Fax: 472-300-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: