Organization
EXPRESS SUPPORT GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK IFEANYI OGBONNA (ADMINISTRATOR)
(919) 876-4949
Entity
Organization
Contact information
Practice address
1801 SAINT ALBANS DR STE G, RALEIGH, NC 27609-6286
(919) 876-4949
(919) 876-4946
Mailing address
1801 SAINT ALBANS DR STE G, RALEIGH, NC 27609-6286
(919) 876-4949
(919) 876-4946
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3747P1801X
Personal Care Attendant
Primary
HC4298
NC
Other
Enumeration date
05/12/2009
Last updated
08/01/2013
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