Organization
THE BRAY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL DIEDRITCH SICKEROTT JR. (OWNER)
(919) 946-1758
Entity
Organization
Contact information
Practice address
2026 FAIRVIEW RD, RALEIGH, NC 27608-2316
(919) 946-1758
Mailing address
2026 FAIRVIEW RD, RALEIGH, NC 27608-2316
(919) 946-1758
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
MHL-092-469
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804353
—
NC
Enumeration date
09/25/2012
Last updated
09/25/2012
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