1417196353 NPI number — WILSON'S HOME CARE AGENCY

Table of content: (NPI 1417196353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417196353 NPI number — WILSON'S HOME CARE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILSON'S HOME CARE AGENCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417196353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7914 MAIN ST.
Provider Second Line Business Mailing Address:
PO BOX 1022
Provider Business Mailing Address City Name:
VANCEBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28586-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-244-3595
Provider Business Mailing Address Fax Number:
252-244-3163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1528 SO EVAN ST.
Provider Second Line Business Practice Location Address:
SIUTE M
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-353-8020
Provider Business Practice Location Address Fax Number:
252-353-8040
Provider Enumeration Date:
02/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WIL;SON
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
252-244-3595

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , with the licence number:  HC2170 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6600834 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com