Provider Demographics
NPI:1942596028
Name:EL SANCTUARY
Entity Type:Organization
Organization Name:EL SANCTUARY
Other - Org Name:THE SANCTUARY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:QETSIYAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:YISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-351-9814
Mailing Address - Street 1:4501 NEW BERN AVE
Mailing Address - Street 2:#130-196
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1549
Mailing Address - Country:US
Mailing Address - Phone:919-351-9814
Mailing Address - Fax:919-255-6119
Practice Address - Street 1:4501 NEW BERN AVE
Practice Address - Street 2:#130-196
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1549
Practice Address - Country:US
Practice Address - Phone:919-351-9814
Practice Address - Fax:919-255-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty