Healthcare Provider Details

I. General information

NPI: 1346766136
Provider Name (Legal Business Name): INVICTUS HEALTHCARE PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 MANOR VALLEY CT APT.002
RALEIGH NC
27613-7071
US

IV. Provider business mailing address

5024 MANOR VALLEY CT APT 2
RALEIGH NC
27613-7330
US

V. Phone/Fax

Practice location:
  • Phone: 919-455-6406
  • Fax:
Mailing address:
  • Phone: 919-455-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. EUNITA OCTAVIA HASKINS
Title or Position: CEO
Credential:
Phone: 919-455-6406