Provider Demographics
NPI:1023383288
Name:IDE CAP SERVICES
Entity Type:Organization
Organization Name:IDE CAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:YLONDA
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-755-0019
Mailing Address - Street 1:4900 WATERS EDGE DR
Mailing Address - Street 2:STE 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2463
Mailing Address - Country:US
Mailing Address - Phone:919-755-0019
Mailing Address - Fax:919-755-0021
Practice Address - Street 1:4900 WATERS EDGE DR
Practice Address - Street 2:STE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2463
Practice Address - Country:US
Practice Address - Phone:919-755-0019
Practice Address - Fax:919-755-0021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDEAL HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4351251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health