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General NPI Number Information
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NPI Number | 1184174690
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Entity Type | Individual
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Provider Name | EBERE COLLINS
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Gender | Female
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 2305 GLASCOCK ST
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City | RALEIGH
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State | NC
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Zip | 27610-1601
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Country | US
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Telephone | 919-896-8233
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Fax | 919-896-8233
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Provider Business Mailing Address
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Address Line | 2804 TREVI FOUNTAIN PL
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City | WAKE FOREST
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State | NC
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Zip | 27587-5928
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Country | US
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Telephone | 919-271-0917
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Fax | 919-896-8233
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL-092-221
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License Number State | NC
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