NPIMap

Organization Active NPI

A W Wholesalers

Doing business as Simply Divine Facilitation Services, LLC

  • Case Management Agency
  • Drakes Branch, VA
National Provider Identifier
1124758834
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
A W WHOLESALERS
Doing business as
Simply Divine Facilitation Services, LLC
Practice address
161 Rose LN
Drakes Branch, VA 23937-2508
Phone
(434) 262-3046
Fax
(434) 226-8104
NPI assigned
Jun 15, 2022
Last updated
Jun 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andreo Ricardo WilsonNPI 1124764527
Title
Owner
Phone
(434) 515-1805

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU Primary
Respite Care 385H00000X NU
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X NU
In Home Supportive Care Agency 253Z00000X NU

Addresses

Primary practice location

161 Rose LN
Drakes Branch, VA 23937-2508

Mailing address

161 Rose LN
Drakes Branch, VA 23937-2508
Phone (434) 262-3046

Other names 1

  • Simply Divine Facilitation Services, LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655251200000",
    "number": "1124758834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 ROSE LN",
            "city": "DRAKES BRANCH",
            "state": "VA",
            "postal_code": "239372508",
            "telephone_number": "434-262-3046",
            "fax_number": "434-226-8104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 ROSE LN",
            "city": "DRAKES BRANCH",
            "state": "VA",
            "postal_code": "239372508",
            "telephone_number": "434-262-3046",
            "fax_number": "434-226-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A W WHOLESALERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ANDREO",
        "authorized_official_middle_name": "RICARDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "434-515-1805"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Simply Divine Facilitation Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Drakes Branch, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.