Provider Demographics
NPI:1811192263
Name:SOUTHEASTERN WAKE ADULT DAY CENTER
Entity Type:Organization
Organization Name:SOUTHEASTERN WAKE ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-212-8580
Mailing Address - Street 1:PO BOX 46775
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-6775
Mailing Address - Country:US
Mailing Address - Phone:919-212-8580
Mailing Address - Fax:919-212-8581
Practice Address - Street 1:3401 CARL SANDBURG CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2049
Practice Address - Country:US
Practice Address - Phone:919-212-8580
Practice Address - Fax:919-212-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-17
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3408446251E00000X
261QA0600X
NCORL-092-001385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408446Medicaid