Provider Demographics
NPI:1326291246
Name:WILLA DEAN MCNEILL
Entity Type:Organization
Organization Name:WILLA DEAN MCNEILL
Other - Org Name:JOYFUL LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLA
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:191-052-7904
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-1477
Mailing Address - Country:US
Mailing Address - Phone:910-864-8000
Mailing Address - Fax:910-864-8001
Practice Address - Street 1:1951 IRELAND DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1504
Practice Address - Country:US
Practice Address - Phone:910-527-9045
Practice Address - Fax:910-864-8007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOYFUL LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-23
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026855320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806101Medicaid