MEDICARE: HIS WILL WORLDWIDE, 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	3104A0625X	Assisted Living Facility (Mental Illness)
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1861796468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIS WILL WORLDWIDE, LLC

Provider Business Mailing Address
First Line	:	4114 JAMES RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-4903
Country	:	US
Telephone Number	:	919-961-7368
Fax Number	:	919-457-1450

Provider Business Practice Location Address
First Line	:	4114 JAMES RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-4903
Country	:	US
Telephone Number	:	919-961-7368
Fax Number	:	919-457-1450

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. BRENDA MICHELLE REID
Credential	:
Telephone Number	:	919-961-7368

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	12/23/2010

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Directions to “HIS WILL WORLDWIDE, LLC ” Practice Location

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