=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043036817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUMAX HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2024
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3221 EDENWOOD DR
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27406-5219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-269-3401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 ROCK QUARRY ROAD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-269-3401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MADUABUCHI IKECHUKWU ONYEGBULE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 984-269-3401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------