Provider Demographics
NPI:1720606122
Name:A WILL TO LIVE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:A WILL TO LIVE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPN
Authorized Official - Phone:919-436-0834
Mailing Address - Street 1:PO BOX 52131
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717-2131
Mailing Address - Country:US
Mailing Address - Phone:919-436-0834
Mailing Address - Fax:
Practice Address - Street 1:109 SOUTH ELM STREET UNIT C
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-436-0834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-12
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care