Provider Demographics
NPI:1538586961
Name:JOHN WILL LIFESTYLE COMPANIONS LLC
Entity type:Organization
Organization Name:JOHN WILL LIFESTYLE COMPANIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-895-1324
Mailing Address - Street 1:6551 COCKRUM ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3044
Mailing Address - Country:US
Mailing Address - Phone:662-895-1324
Mailing Address - Fax:
Practice Address - Street 1:6551 COCKRUM ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3044
Practice Address - Country:US
Practice Address - Phone:662-895-1324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1027405253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care