Healthcare Provider Details

I. General information

NPI: 1487225397
Provider Name (Legal Business Name): MANAGEMENT CONSULTANTS PRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 PROFESSIONAL COURT STE 201
RALEIGH NC
27619-2761
US

IV. Provider business mailing address

2924 TRASSACKS DR
RALEIGH NC
27610-5497
US

V. Phone/Fax

Practice location:
  • Phone: 984-202-5645
  • Fax:
Mailing address:
  • Phone: 252-548-9303
  • 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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRYAN DOREKO PAUL SMITH
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 252-548-9303