Healthcare Provider Details

I. General information

NPI: 1932046372
Provider Name (Legal Business Name): WIMBA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 WINDSONG DR
FAIRVIEW NC
28730-9700
US

IV. Provider business mailing address

34 WINDSONG DR
FAIRVIEW NC
28730-9700
US

V. Phone/Fax

Practice location:
  • Phone: 828-412-1013
  • Fax:
Mailing address:
  • Phone: 828-412-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEROME BOUILLON
Title or Position: OWNER DIRECTOR
Credential:
Phone: 828-412-1013