Healthcare Provider Details

I. General information

NPI: 1396675476
Provider Name (Legal Business Name): BYRDWISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 CONNELL DR
RALEIGH NC
27612-5604
US

IV. Provider business mailing address

4030 WAKE FOREST RD STE 349
RALEIGH NC
27609-0010
US

V. Phone/Fax

Practice location:
  • Phone: 984-252-2611
  • Fax:
Mailing address:
  • Phone: 984-252-2611
  • 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: CLARENCE BYRD JR.
Title or Position: FOUNDER/CEO
Credential: RN, MSN
Phone: 984-252-2611