Organization Name: | EXPRESS SUPPORT GROUP, LLC |
NPI Number: | 1104240936 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATRICK I OGBONNA (PRESIDENT) |
Mailing Address: | 1801 Saint Albans Dr Ste G Raleigh |
State: | NC US |
Postal Code: | 276096286 |
Phone Number: | 9198764949 |
Fax Number: | 9198764946 |
NPI Enumeration Date: | 02/14/2014 |
NPI Last Update Date: | 02/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 253Z00000X |
License Number: | HC 4472 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Agencies |
Taxonomy Classification: | In Home Supportive Care |
Taxonomy Specialization: | |
Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |