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General NPI Number Information
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NPI Number | 1083994164
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Entity Type | Organization
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Legal Business Name | HIS WILL WORLDWIDE, LLC
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 4114 JAMES RD
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City | RALEIGH
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State | NC
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Zip | 27604-4903
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Country | US
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Telephone | 919-872-1790
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Fax | 919-872-1790
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Provider Business Mailing Address
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Address Line | PO BOX 58268
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City | RALEIGH
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State | NC
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Zip | 27658-8268
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Country | US
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Telephone | 919-673-7352
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Fax | 919-457-1450
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BRENDA MICHELLE REID
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Credential |
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Telephone | 919-872-1790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL-092-168
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License Number State | NC
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