Healthcare Provider Details

I. General information

NPI: 1114034121
Provider Name (Legal Business Name): HOSPICE OF WAKE COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

IV. Provider business mailing address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

V. Phone/Fax

Practice location:
  • Phone: 919-828-0890
  • Fax: 919-719-0395
Mailing address:
  • Phone: 919-828-0890
  • Fax: 919-719-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TONI MESSLER
Title or Position: VP OF FINANCE AND OPERATIONS
Credential:
Phone: 919-828-0890