=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750039871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACESS1 HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2022
-----------------------------------------------------
Last Update Date | 03/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 ATLANTIC SPRINGS RD STE 111
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27616-1856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-803-6820
-----------------------------------------------------
Fax | 919-803-6820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 ATLANTIC SPRINGS RD STE 111
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27616-1856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-803-6820
-----------------------------------------------------
Fax | 919-803-6820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. EMMANUEL O AYALOGU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-740-3601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------