Healthcare Provider Details

I. General information

NPI: 1306445648
Provider Name (Legal Business Name): GOOD HOPE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 SAINT GILES ST STE 210
RALEIGH NC
27612-7046
US

IV. Provider business mailing address

6120 SAINT GILES ST STE 210
RALEIGH NC
27612-7046
US

V. Phone/Fax

Practice location:
  • Phone: 919-803-6440
  • Fax: 919-803-6740
Mailing address:
  • Phone: 919-803-6440
  • Fax: 919-803-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: UCHE L OBI
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 919-889-2906