Provider Demographics
NPI:1366587578
Name:INEZS HOUSE HC LLC
Entity type:Organization
Organization Name:INEZS HOUSE HC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HATTIE
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-697-7340
Mailing Address - Street 1:209 GANYARD FARM WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703
Mailing Address - Country:US
Mailing Address - Phone:919-697-7340
Mailing Address - Fax:919-479-9055
Practice Address - Street 1:2811 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703
Practice Address - Country:US
Practice Address - Phone:919-697-7340
Practice Address - Fax:919-479-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-356311ZA0620X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805440Medicaid