MEDICARE: THE WILLIS FAMILY HOME CARE FACILITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1205361573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WILLIS FAMILY HOME CARE FACILITY

Provider Business Mailing Address
First Line	:	1811 SANDTRAP CT
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-3875
Country	:	US
Telephone Number	:	863-386-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 W THOMAS ST
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-4331
Country	:	US
Telephone Number	:	252-231-0632
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DEBORAH ANN WEATHERS
Credential	:	OWNER
Telephone Number	:	863-386-1609

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/25/2017

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