Provider Demographics
NPI:1083994164
Name:HIS WILL WORLDWIDE, LLC
Entity Type:Organization
Organization Name:HIS WILL WORLDWIDE, LLC
Other - Org Name:BE WELL FAMILY CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-872-1790
Mailing Address - Street 1:PO BOX 58268
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27658-8268
Mailing Address - Country:US
Mailing Address - Phone:919-673-7352
Mailing Address - Fax:919-457-1450
Practice Address - Street 1:4114 JAMES RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-4903
Practice Address - Country:US
Practice Address - Phone:919-872-1790
Practice Address - Fax:919-872-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-092-168311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home