Provider Demographics
NPI:1407907264
Name:WAKE COUNTY HUMAN SERVICES
Entity Type:Organization
Organization Name:WAKE COUNTY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN EXTENDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:HAGWOOD
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:919-250-1561
Mailing Address - Street 1:10 SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1808
Mailing Address - Country:US
Mailing Address - Phone:919-250-1561
Mailing Address - Fax:919-250-4429
Practice Address - Street 1:10 SUNNYBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1808
Practice Address - Country:US
Practice Address - Phone:919-250-1561
Practice Address - Fax:919-250-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500575261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7963348Medicaid