Provider Demographics
NPI:1659973998
Name:EAST WAKE HOME CARE
Entity Type:Organization
Organization Name:EAST WAKE HOME CARE
Other - Org Name:EAST WAKE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN/ AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-759-8891
Mailing Address - Street 1:101 FOREST DR STE B
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9603
Mailing Address - Country:US
Mailing Address - Phone:757-759-8891
Mailing Address - Fax:
Practice Address - Street 1:101 FOREST DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9603
Practice Address - Country:US
Practice Address - Phone:919-307-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care