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Mr. Carl Diedritch Sickerott JR.
Adult Care Home Facility in Raleigh, North Carolina
NPI 1518214022

Carl Diedritch Sickerott JR. is an Adult Care Home Facility based in Raleigh, NC and is specialized in Adult Care Home. Carl Diedritch Sickerott JR. practices in Raleigh, NC. The NPI Number for Carl Diedritch Sickerott JR. is 1518214022 and holds a License No. MHL-092-469 (North Carolina).

The current practice location address for Carl Diedritch Sickerott JR. is 2026 Fairview Rd, Raleigh, NC and can be reached out via phone at 919-946-1758.

Location: 2026 Fairview Rd, Raleigh, NC, 27608-2316
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1518214022
Provider Name
Carl Diedritch Sickerott JR.
Credential
Provider Entity Type
Individual
Gender
Male
Address
2026 Fairview Rd, Raleigh, NC, 27608-2316
Phone Number
919-946-1758
Fax Number
Provider Enumeration Date
08/14/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
7804353 05 NC
institution
Provider Business Practice Location Address Details
Address
2026 Fairview Rd
City
Raleigh
State
North Carolina
Zip
27608-2316
Phone Number
919-946-1758
Fax Number
person
Provider Business Mailing Address Details
Address
2026 Fairview Rd
City
Raleigh
State
North Carolina
Zip
27608-2316
Phone Number
919-946-1758
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Custodial Care Facility
Speciality
Adult Care Home
Taxonomy
311ZA0620X
License No.
MHL-092-469 (North Carolina)
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
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