Provider Demographics
NPI:1467435842
Name:WAKEMED
Entity Type:Organization
Organization Name:WAKEMED
Other - Org Name:WAKEMED HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, HOME HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLUCAS-INGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-350-0236
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1015
Mailing Address - Country:US
Mailing Address - Phone:919-350-7990
Mailing Address - Fax:919-350-0111
Practice Address - Street 1:2920 HIGHWOODS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1015
Practice Address - Country:US
Practice Address - Phone:919-350-7990
Practice Address - Fax:919-350-0111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKEMED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-21
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1293251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC347179OtherMEDICARE
NC0070HOtherBCBS PROVIDER NUMBER
NC3417179Medicaid
NC347179Medicare Oscar/Certification