Provider Demographics
NPI:1003202755
Name:COARK INC
Entity type:Organization
Organization Name:COARK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIGWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-395-5202
Mailing Address - Street 1:6711 HARTER CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6589
Mailing Address - Country:US
Mailing Address - Phone:919-395-5202
Mailing Address - Fax:
Practice Address - Street 1:3535 S WILMINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3562
Practice Address - Country:US
Practice Address - Phone:919-395-5202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COARK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4749251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health