Provider Demographics
NPI:1437507563
Name:MINNIE INC
Entity Type:Organization
Organization Name:MINNIE INC
Other - Org Name:COMFORCARE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-542-2520
Mailing Address - Street 1:3761 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5263
Mailing Address - Country:US
Mailing Address - Phone:919-542-2520
Mailing Address - Fax:919-545-5540
Practice Address - Street 1:3761 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-5263
Practice Address - Country:US
Practice Address - Phone:919-542-2520
Practice Address - Fax:919-545-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3443251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health