Healthcare Provider Details

I. General information

NPI: 1538054077
Provider Name (Legal Business Name): EZEKIEL UGWU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 ALFALFA LN
WAKE FOREST NC
27587-3040
US

IV. Provider business mailing address

6445 ALFALFA LN
WAKE FOREST NC
27587-3040
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-5109
  • Fax:
Mailing address:
  • Phone: 919-638-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC7959
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: