MEDICARE: LK WILLIAMS HOME CARE LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1265806467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LK WILLIAMS HOME CARE LLC

Provider Business Mailing Address
First Line	:	3316 SEWELLS POINT RD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2237
Country	:	US
Telephone Number	:	757-581-3247
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 SEWELLS POINT RD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2237
Country	:	US
Telephone Number	:	757-581-3247
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURELLE L MOSELEY
Credential	:
Telephone Number	:	757-581-3247

Provider Enumeration Date	:	11/25/2015
Last Update Date	:	11/25/2015

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