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General NPI Number Information
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NPI Number | 1366135071
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE HOME OF WELLNESS LLC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 2038 MAITLAND DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-6296
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Country | US
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Telephone | 910-728-5594
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Fax |
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Provider Business Mailing Address
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Address Line | 2038 MAITLAND DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-6296
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Country | US
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Telephone | 910-728-5594
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | LILA HUFF
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Credential |
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Telephone | 191-072-8559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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