Provider Demographics
NPI:1144458225
Name:PRIVILEGE CARE PLUS INC
Entity type:Organization
Organization Name:PRIVILEGE CARE PLUS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DYONISIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:919-223-5208
Mailing Address - Street 1:908 FAYETTEVILLE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3982
Mailing Address - Country:US
Mailing Address - Phone:919-223-5208
Mailing Address - Fax:
Practice Address - Street 1:908 FAYETTEVILLE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3982
Practice Address - Country:US
Practice Address - Phone:919-223-5208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIVILGE CARE PLUS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization