Healthcare Provider Details

I. General information

NPI: 1538427299
Provider Name (Legal Business Name): SUPPLEMENTAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 GLENWOOD AVE STE 160
RALEIGH NC
27608-1367
US

IV. Provider business mailing address

2626 GLENWOOD AVE STE 160
RALEIGH NC
27608-1367
US

V. Phone/Fax

Practice location:
  • Phone: 191-978-1956
  • Fax:
Mailing address:
  • Phone:
  • 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: EMILY DNISTRAN
Title or Position: SENIOR STAFFING MANAGER
Credential:
Phone: 919-781-9565