Healthcare Provider Details

I. General information

NPI: 1861796468
Provider Name (Legal Business Name): HIS WILL WORLDWIDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 JAMES RD
RALEIGH NC
27604-4903
US

IV. Provider business mailing address

4114 JAMES RD
RALEIGH NC
27604-4903
US

V. Phone/Fax

Practice location:
  • Phone: 919-961-7368
  • Fax: 919-457-1450
Mailing address:
  • Phone: 919-961-7368
  • Fax: 919-457-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA MICHELLE REID
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-961-7368