Healthcare Provider Details

I. General information

NPI: 1922921378
Provider Name (Legal Business Name): OUR LEGACY OF LOVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 WOOTEN BLVD SW STE F
WILSON NC
27893-4463
US

IV. Provider business mailing address

2403 WOOTEN BLVD SW STE F
WILSON NC
27893-4463
US

V. Phone/Fax

Practice location:
  • Phone: 252-886-5711
  • Fax:
Mailing address:
  • Phone: 252-886-5711
  • 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: MS. AVIS MITCHELL
Title or Position: DIRECTOR
Credential:
Phone: 252-886-5711