Provider Demographics
NPI:1235916636
Name:1134468564
Entity Type:Organization
Organization Name:1134468564
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANESHA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-354-5400
Mailing Address - Street 1:7841 ALEXANDER PROMENADE PL # S100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-1913
Mailing Address - Country:US
Mailing Address - Phone:919-354-5400
Mailing Address - Fax:919-354-5401
Practice Address - Street 1:7841 ALEXANDER PROMENADE PL # S100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-1913
Practice Address - Country:US
Practice Address - Phone:919-354-5400
Practice Address - Fax:919-354-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental