Provider Demographics
NPI:1871485078
Name:MID-CAROLINA REGIONAL COUNCIL AAA
Entity type:Organization
Organization Name:MID-CAROLINA REGIONAL COUNCIL AAA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WULLENWABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-536-3552
Mailing Address - Street 1:6205 RAEFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2425
Mailing Address - Country:US
Mailing Address - Phone:919-536-3552
Mailing Address - Fax:910-323-9330
Practice Address - Street 1:6205 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2425
Practice Address - Country:US
Practice Address - Phone:919-536-3552
Practice Address - Fax:910-323-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care