Provider Demographics
NPI:1013107655
Name:AA MANTEL HEALTHCARE
Entity Type:Organization
Organization Name:AA MANTEL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OBOMANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-401-8381
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-0038
Mailing Address - Country:US
Mailing Address - Phone:919-401-8381
Mailing Address - Fax:919-490-6466
Practice Address - Street 1:3600 UNIVERSITY DR
Practice Address - Street 2:SUITE A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6207
Practice Address - Country:US
Practice Address - Phone:919-401-8381
Practice Address - Fax:919-490-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2309251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health