Healthcare Provider Details

I. General information

NPI: 1750069167
Provider Name (Legal Business Name): URBAN DLUXE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 BAY HARBOR DR
RALEIGH NC
27604-4094
US

IV. Provider business mailing address

2440 BAY HARBOR DR
RALEIGH NC
27604-4094
US

V. Phone/Fax

Practice location:
  • Phone: 917-573-8493
  • Fax:
Mailing address:
  • Phone: 917-573-8493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DEREK JERMAINE SCURRY
Title or Position: CEO
Credential: N/A
Phone: 917-573-8493