Healthcare Provider Details

I. General information

NPI: 1922910215
Provider Name (Legal Business Name): PACK HOME HEALTH CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 FORESTFORD CT
RALEIGH NC
27610-6689
US

IV. Provider business mailing address

1312 FORESTFORD CT
RALEIGH NC
27610-6689
US

V. Phone/Fax

Practice location:
  • Phone: 917-586-8217
  • Fax:
Mailing address:
  • Phone: 917-586-8217
  • 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: KEHINDE O AJIROTUTU
Title or Position: DIRECTOR
Credential:
Phone: 917-586-8217