Healthcare Provider Details

I. General information

NPI: 1821916420
Provider Name (Legal Business Name): CILLES REI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 GLENWOOD AVE
RALEIGH NC
27612-3856
US

IV. Provider business mailing address

4801 GLENWOOD AVE
RALEIGH NC
27612-3856
US

V. Phone/Fax

Practice location:
  • Phone: 984-397-1828
  • Fax: 984-397-1894
Mailing address:
  • Phone: 984-397-1828
  • Fax: 984-397-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LUCILLE NICHOLSON
Title or Position: ASSETS MANAGER
Credential:
Phone: 984-397-1828