Provider Demographics
NPI:1902190796
Name:CONKEL IMAGE HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:CONKEL IMAGE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KELECHI
Authorized Official - Middle Name:C
Authorized Official - Last Name:UWAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:919-264-9769
Mailing Address - Street 1:6835 HORSEBACK LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2685
Mailing Address - Country:US
Mailing Address - Phone:919-264-9769
Mailing Address - Fax:866-211-0358
Practice Address - Street 1:405 AVERSBORO RD STE 400
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3869
Practice Address - Country:US
Practice Address - Phone:919-264-9769
Practice Address - Fax:866-211-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4383253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care