Provider Demographics
NPI:1003215195
Name:DURHAM CENTER FOR SENIOR LIFE
Entity type:Organization
Organization Name:DURHAM CENTER FOR SENIOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEANYEA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-688-8247
Mailing Address - Street 1:406 RIGSBEE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2186
Mailing Address - Country:US
Mailing Address - Phone:919-688-8247
Mailing Address - Fax:919-683-3406
Practice Address - Street 1:406 RIGSBEE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2186
Practice Address - Country:US
Practice Address - Phone:919-688-8247
Practice Address - Fax:919-683-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000615311ZA0620X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home