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General NPI Number Information
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NPI Number | 1003122557
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Entity Type | Organization
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Legal Business Name | DYNAMEDICS HEALTHCARE SERVICES, INC
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Dates
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Enumeration Date | 08/22/2010
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Last Update Date | 08/22/2010
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Provider Practice Location Address
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Address Line | 3755 BENSON DR
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City | RALEIGH
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State | NC
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Zip | 27609-7386
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Country | US
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Telephone | 919-995-0554
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41474
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City | RALEIGH
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State | NC
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Zip | 27629-1474
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAM O.S. ECHENDU
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Credential |
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Telephone | 919-995-0554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC4160
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License Number State | NC
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