Provider Demographics
NPI:1972188217
Name:AHAVA HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:AHAVA HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-667-4649
Mailing Address - Street 1:200 OAK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2227
Mailing Address - Country:US
Mailing Address - Phone:919-667-4649
Mailing Address - Fax:919-377-2262
Practice Address - Street 1:17001 SEARSTONE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8385
Practice Address - Country:US
Practice Address - Phone:919-234-0318
Practice Address - Fax:919-234-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1578165346OtherSEARSTONE RETIREMENT COMMUNITY