Healthcare Provider Details

I. General information

NPI: 1669940201
Provider Name (Legal Business Name): DAVESTEL HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HANSKA WAY
RALEIGH NC
27610-2268
US

IV. Provider business mailing address

801 HANSKA WAY
RALEIGH NC
27610-2268
US

V. Phone/Fax

Practice location:
  • Phone: 919-345-8897
  • Fax:
Mailing address:
  • Phone: 919-345-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN ADIMA
Title or Position: DIRECTOR
Credential:
Phone: 919-345-8897