Organization
A W WHOLESALERS
Active
Other names
Simply Divine Facilitation Services, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREO RICARDO WILSON (OWNER)
(434) 515-1805
Entity
Organization
Contact information
Practice address
161 ROSE LN, DRAKES BRANCH, VA 23937-2508
(434) 262-3046
(434) 226-8104
Mailing address
161 ROSE LN, DRAKES BRANCH, VA 23937-2508
(434) 262-3046
(434) 226-8104
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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