Healthcare Provider Details

I. General information

NPI: 1982514790
Provider Name (Legal Business Name): ANCIENT PATH FARMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SOMMERVILLE PARK RD
RALEIGH NC
27603-4756
US

IV. Provider business mailing address

3489 US HIGHWAY 117 S
BURGAW NC
28425-3001
US

V. Phone/Fax

Practice location:
  • Phone: 910-352-7603
  • Fax:
Mailing address:
  • Phone: 910-352-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MRS. TALPHA HARRIS
Title or Position: OWNER
Credential:
Phone: 910-352-7603