Healthcare Provider Details

I. General information

NPI: 1144988130
Provider Name (Legal Business Name): ROKON BUREH HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 SIX FORKS RD STE 400
RALEIGH NC
27615-2965
US

IV. Provider business mailing address

8601 SIX FORKS RD STE 400
RALEIGH NC
27615-2965
US

V. Phone/Fax

Practice location:
  • Phone: 301-613-5042
  • Fax:
Mailing address:
  • Phone: 301-613-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FATMATA FOFANAH
Title or Position: OWNER
Credential:
Phone: 301-613-5042