Healthcare Provider Details

I. General information

NPI: 1629093026
Provider Name (Legal Business Name): WILSON'S HOME CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7914 MAIN ST
VANCEBORO NC
28586-1022
US

IV. Provider business mailing address

PO BOX 1022
VANCEBORO NC
28586-1022
US

V. Phone/Fax

Practice location:
  • Phone: 252-244-3595
  • Fax: 252-244-3163
Mailing address:
  • Phone: 252-244-3595
  • Fax: 252-244-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC1762
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC1762
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC2067
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC2170
License Number StateNC

VIII. Authorized Official

Name: MRS. BRENDA ANN WILSON
Title or Position: OWNER/PRESIDENT
Credential: RN
Phone: 252-244-3595