MEDICARE: CENECA PARK DEVELOPERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency
3	347C00000X	Private Vehicle
4	332U00000X	Home Delivered Meals
5	385H00000X	Respite Care
6	174200000X	Meals Provider
7	343900000X	Non-emergency Medical Transport (VAN)
8	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1245049436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENECA PARK DEVELOPERS LLC

Provider Business Mailing Address
First Line	:	8801 STEPHENSON RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27539-7281
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4208 SIX FORKS RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-5733
Country	:	US
Telephone Number	:	919-295-6197
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHANDRA PLATZ
Credential	:
Telephone Number	:	413-687-0507

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	03/30/2026

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