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General NPI Number Information
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NPI Number | 1720606122
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Entity Type | Organization
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Legal Business Name | A WILL TO LIVE HOME HEALTH, LLC
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Dates
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Enumeration Date | 07/12/2020
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Last Update Date | 07/12/2020
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Provider Practice Location Address
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Address Line | 109 SOUTH ELM STREET UNIT C
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City | CREEDMOOR
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State | NC
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Zip | 27522
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Country | US
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Telephone | 919-436-0834
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52131
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City | DURHAM
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State | NC
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Zip | 27717-2131
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Country | US
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Telephone | 919-436-0834
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALBERT WILMER JR.
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Credential | LPN
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Telephone | 919-436-0834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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