Healthcare Provider Details

I. General information

NPI: 1841429164
Provider Name (Legal Business Name): STRAIGHT WALK FAMILY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 ELIZABETH BENNET PLACE
RALEIGH NC
27616
US

IV. Provider business mailing address

8911 ELIZABETH BENNET PLACE
RALEIGH NC
27616
US

V. Phone/Fax

Practice location:
  • Phone: 252-258-5175
  • Fax:
Mailing address:
  • Phone: 252-258-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. DONNA LATIMER
Title or Position: MANAGER
Credential:
Phone: 252-258-5176