Provider Demographics
NPI:1881078525
Name:CR3 DIABETES ASSOCIATION, INC.
Entity type:Organization
Organization Name:CR3 DIABETES ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:RAY
Authorized Official - Suffix:III
Authorized Official - Credentials:N/A
Authorized Official - Phone:919-303-6949
Mailing Address - Street 1:121 EDINBURGH SOUTH DR
Mailing Address - Street 2:208
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6448
Mailing Address - Country:US
Mailing Address - Phone:919-303-6949
Mailing Address - Fax:919-267-9629
Practice Address - Street 1:121 EDINBURGH SOUTH DR
Practice Address - Street 2:208
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6448
Practice Address - Country:US
Practice Address - Phone:919-303-6949
Practice Address - Fax:919-267-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02159332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies