Healthcare Provider Details

I. General information

NPI: 1558911636
Provider Name (Legal Business Name): LILA HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LAMON ST STE 114
FAYETTEVILLE NC
28301-4917
US

IV. Provider business mailing address

111 LAMON ST STE 114
FAYETTEVILLE NC
28301-4917
US

V. Phone/Fax

Practice location:
  • Phone: 910-728-5594
  • Fax: 910-835-5149
Mailing address:
  • Phone: 910-728-5594
  • Fax: 910-835-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: