Healthcare Provider Details

I. General information

NPI: 1366369118
Provider Name (Legal Business Name): BLOODBOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 SIX FORKS RD STE 200
RALEIGH NC
27615-6525
US

IV. Provider business mailing address

2311 BRIGHTCREEK FALLS TRL APT 300
RALEIGH NC
27610-9071
US

V. Phone/Fax

Practice location:
  • Phone: 984-386-1089
  • Fax:
Mailing address:
  • Phone: 984-386-1089
  • 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: REGINA JOHNSON
Title or Position: CERTIFIED PHLEBOTOMIST
Credential:
Phone: 984-386-1089