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General NPI Number Information
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NPI Number | 1982933388
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Entity Type | Organization
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Legal Business Name | FOR LIFE WELLNESS,LLC
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 2423 HWY 401 BUSINESS
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City | RAEFORD
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State | NC
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Zip | 28376-5778
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Country | US
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Telephone | 910-904-0297
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Fax | 910-904-0296
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Provider Business Mailing Address
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Address Line | PO BOX 1867
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City | RAEFORD
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State | NC
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Zip | 28376-3867
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Country | US
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Telephone | 910-904-0297
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Fax | 910-904-0296
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. AKILIA HOLLIDAY SLOCUMB
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Credential |
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Telephone | 910-904-0297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC3967
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License Number State | NC
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