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General NPI Number Information
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NPI Number | 1083412613
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Entity Type | Individual
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Provider Name | THEOPHILUS IMBUFE DHA
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Gender | Male
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1983 FAIRFOREST DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2612
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Country | US
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Telephone | 910-733-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 4030 WAKE FOREST RD STE 349
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City | RALEIGH
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State | NC
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Zip | 27609-0010
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Country | US
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Telephone | 910-541-5188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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