Organization
PETER-ELST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLAYIDE OLANIYAN B.A/QP (CHIEF EXECUTIVE OFFICER)
(919) 401-6655
Entity
Organization
Contact information
Practice address
3700 LYCKAN PKWY STE A, DURHAM, NC 27707-2587
(919) 401-6655
Mailing address
3700 LYCKAN PKWY STE A, DURHAM, NC 27707-2587
(919) 401-6655
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418993
—
NC
Enumeration date
09/15/2009
Last updated
03/08/2018
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