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NPI Code Detail

MEDICARE: WAKE ENTERPRISES INC

MEDICARE: WAKE ENTERPRISES INC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1251C00000XDevelopmentally Disabled Services Day Training AgencyMHL092006NC

General Provider Information

NPI Number : 1497894042
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAKE ENTERPRISES INC
Provider Business Mailing Address
First Line : 3548 BUSH ST
Second Line :
City : RALEIGH
State : NC
Zip : 27609-7509
Country : US
Telephone Number : 919-714-6100
Fax Number :
Provider Business Practice Location Address
First Line : 3548 BUSH ST
Second Line :
City : RALEIGH
State : NC
Zip : 27609-7509
Country : US
Telephone Number : 919-714-6100
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. WALTER WEEKS
Credential :
Telephone Number : 919-714-6121
Provider Enumeration Date : 02/06/2007
Last Update Date : 02/20/2012

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Directions to “WAKE ENTERPRISES INC ” Practice Location

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