Healthcare Provider Details

I. General information

NPI: 1710261813
Provider Name (Legal Business Name): DAWN THOMAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 RIVER CHASE DR
RALEIGH NC
27610-9708
US

IV. Provider business mailing address

1109 RIVER CHASE DR
RALEIGH NC
27610-9708
US

V. Phone/Fax

Practice location:
  • Phone: 919-526-4028
  • Fax:
Mailing address:
  • Phone: 919-526-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6293
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number6293
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number6293
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number6293
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number6293
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number6293
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number6293
License Number StateNC

VIII. Authorized Official

Name: MRS. DAWN CHRISTINE THOMAS
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: SLP-CCC
Phone: 919-526-4028