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General NPI Number Information
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NPI Number | 1467435842
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Entity Type | Organization
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Legal Business Name | WAKEMED
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 2920 HIGHWOODS BLVD SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27604-1015
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Country | US
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Telephone | 919-350-7990
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Fax | 919-350-0111
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Provider Business Mailing Address
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Address Line | 2920 HIGHWOODS BLVD SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27604-1015
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Country | US
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Telephone | 919-350-7990
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Fax | 919-350-0111
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, HOME HEALTH
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Name | MS. JENNIFER MCLUCAS-INGOLD
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Credential |
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Telephone | 919-350-0236
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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 | HC1293
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License Number State | NC
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