Provider Demographics
NPI:1326034208
Name:WAKE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:WAKE HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINIANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-250-2939
Mailing Address - Street 1:102 N TARBORO RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2352
Mailing Address - Country:US
Mailing Address - Phone:919-743-3315
Mailing Address - Fax:919-743-0580
Practice Address - Street 1:102 N TARBORO RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2352
Practice Address - Country:US
Practice Address - Phone:919-743-3315
Practice Address - Fax:919-743-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344589AMedicaid
NC344589AMedicaid