Provider Demographics
NPI:1518209048
Name:LILMOMMASHOME HEALTH CARE,LLC
Entity Type:Organization
Organization Name:LILMOMMASHOME HEALTH CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:WILLIAMS-
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:540-353-8626
Mailing Address - Street 1:3739 SOUTHWAY DR SW APT 41
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2265
Mailing Address - Country:US
Mailing Address - Phone:540-353-6826
Mailing Address - Fax:
Practice Address - Street 1:3739 SOUTHWAY DR SW APT 41
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2265
Practice Address - Country:US
Practice Address - Phone:540-353-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E0000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health