Provider Demographics
NPI:1619567815
Name:KOODY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:KOODY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OHIAERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-271-4401
Mailing Address - Street 1:5420 SEASPRAY LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5792
Mailing Address - Country:US
Mailing Address - Phone:919-271-4401
Mailing Address - Fax:
Practice Address - Street 1:1805 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5322
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home