Healthcare Provider Details

I. General information

NPI: 1245049436
Provider Name (Legal Business Name): CENECA PARK DEVELOPERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 SIX FORKS RD
RALEIGH NC
27609-5733
US

IV. Provider business mailing address

8801 STEPHENSON RD
APEX NC
27539-7281
US

V. Phone/Fax

Practice location:
  • Phone: 919-295-6197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHANDRA PLATZ
Title or Position: DIRECTOR
Credential:
Phone: 413-687-0507