Healthcare Provider Details

I. General information

NPI: 1811192263
Provider Name (Legal Business Name): SOUTHEASTERN WAKE ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2007
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CARL SANDBURG CT
RALEIGH NC
27610-2049
US

IV. Provider business mailing address

PO BOX 46775
RALEIGH NC
27620-6775
US

V. Phone/Fax

Practice location:
  • Phone: 919-212-8580
  • Fax: 919-212-8581
Mailing address:
  • Phone: 919-212-8580
  • Fax: 919-212-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberORL-092-001
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3408446
License Number StateNC

VIII. Authorized Official

Name: EVELYN SANDERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-212-8580