Healthcare Provider Details

I. General information

NPI: 1619884665
Provider Name (Legal Business Name): COMMUNITYCARE MEDICAL TRANSIT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 BOWMAN LN
RALEIGH NC
27610-5007
US

IV. Provider business mailing address

2005 BOWMAN LN
RALEIGH NC
27610-5007
US

V. Phone/Fax

Practice location:
  • Phone: 919-633-3313
  • Fax:
Mailing address:
  • Phone: 919-633-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TY KIAKU
Title or Position: PRESIDENT
Credential:
Phone: 919-633-3313