Healthcare Provider Details

I. General information

NPI: 1306150040
Provider Name (Legal Business Name): CARDEA HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 FAST PARK DR SUITE 211
RALEIGH NC
27617-4852
US

IV. Provider business mailing address

8801 FAST PARK DR SUITE 211
RALEIGH NC
27617-4852
US

V. Phone/Fax

Practice location:
  • Phone: 919-786-5052
  • Fax: 919-786-5067
Mailing address:
  • Phone: 919-786-5052
  • Fax: 919-786-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4152
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberHC4152
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC4152
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC4152
License Number StateNC

VIII. Authorized Official

Name: MS. CAROL LEA CANELAS
Title or Position: AGENCY DIRECTOR
Credential: RN, BSN, MA
Phone: 919-786-5052