Provider Demographics
NPI:1700115284
Name:VAGAP HEALTH
Entity Type:Organization
Organization Name:VAGAP HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OBI
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH, QP
Authorized Official - Phone:919-779-7779
Mailing Address - Street 1:PO BOX 41505
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27629-1505
Mailing Address - Country:US
Mailing Address - Phone:919-779-7779
Mailing Address - Fax:919-424-7185
Practice Address - Street 1:6004 RICKER RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4281
Practice Address - Country:US
Practice Address - Phone:919-779-7779
Practice Address - Fax:919-424-7185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-7533104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness