Healthcare Provider Details

I. General information

NPI: 1144907676
Provider Name (Legal Business Name): WHOLE HEARTED HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 WAKE FOREST RD STE 2G
RALEIGH NC
27609-6160
US

IV. Provider business mailing address

4312 WAKE FOREST RD STE 2G
RALEIGH NC
27609-6160
US

V. Phone/Fax

Practice location:
  • Phone: 984-238-5741
  • Fax:
Mailing address:
  • Phone: 252-673-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHANEIKA DEANE CAVINESS
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 252-673-5786