Provider Demographics
NPI:1205048766
Name:ACCESS HEALTH SYSTEM 1, CORP
Entity type:Organization
Organization Name:ACCESS HEALTH SYSTEM 1, CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:OGUGUA
Authorized Official - Last Name:ILONZE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:919-349-3807
Mailing Address - Street 1:5132 DICE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5655
Mailing Address - Country:US
Mailing Address - Phone:919-747-9514
Mailing Address - Fax:919-341-0486
Practice Address - Street 1:5132 DICE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5655
Practice Address - Country:US
Practice Address - Phone:919-747-9514
Practice Address - Fax:919-341-0486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS HEALTH SYSTEM 1 CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-04
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806244Medicaid
NC7806698Medicaid
NC7806244Medicaid