MEDICARE: LILY HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		NC

General Provider Information

NPI Number	:	1700016342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILY HEALTHCARE

Provider Business Mailing Address
First Line	:	2650 DISCOVERY DRIVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 DISCOVERY DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-1908
Country	:	US
Telephone Number	:	404-606-4035
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	APRIL HOFFMAN
Credential	:
Telephone Number	:	404-606-4035

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	07/16/2009

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Directions to “LILY HEALTHCARE ” Practice Location

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