Healthcare Provider Details

I. General information

NPI: 1417810557
Provider Name (Legal Business Name): THE VILLAGE HOME CARE LTD. LIABILITY CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NASH ST W
WILSON NC
27893-4012
US

IV. Provider business mailing address

121 NASH ST W
WILSON NC
27893-4012
US

V. Phone/Fax

Practice location:
  • Phone: 919-288-8645
  • Fax:
Mailing address:
  • Phone:
  • 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: LAKEISHA PETEN
Title or Position: OWNER
Credential:
Phone: 919-288-8645