Healthcare Provider Details

I. General information

NPI: 1982933388
Provider Name (Legal Business Name): FOR LIFE WELLNESS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 HWY 401 BUSINESS
RAEFORD NC
28376-5778
US

IV. Provider business mailing address

PO BOX 1867
RAEFORD NC
28376-3867
US

V. Phone/Fax

Practice location:
  • Phone: 910-904-0297
  • Fax: 910-904-0296
Mailing address:
  • Phone: 910-904-0297
  • Fax: 910-904-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3967
License Number StateNC

VIII. Authorized Official

Name: MRS. AKILIA HOLLIDAY SLOCUMB
Title or Position: DIRECTOR
Credential:
Phone: 910-904-0297