Provider Demographics
NPI:1679851356
Name:SUPPLEMENTAL HEALTH CARE
Entity Type:Organization
Organization Name:SUPPLEMENTAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR STAFFING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DNISTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-781-9565
Mailing Address - Street 1:2626 GLENWOOD AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1043
Mailing Address - Country:US
Mailing Address - Phone:919-781-9564
Mailing Address - Fax:919-781-9564
Practice Address - Street 1:2626 GLENWOOD AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-1043
Practice Address - Country:US
Practice Address - Phone:919-781-9565
Practice Address - Fax:919-781-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0542224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty