Healthcare Provider Details

I. General information

NPI: 1427365865
Provider Name (Legal Business Name): WILKES COUNTY ADULT CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 RESTHOME RD
WILKESBORO NC
28697-7145
US

IV. Provider business mailing address

176 RESTHOME RD
WILKESBORO NC
28697-7145
US

V. Phone/Fax

Practice location:
  • Phone: 336-973-3890
  • Fax: 336-973-3042
Mailing address:
  • Phone: 336-973-3890
  • Fax: 336-973-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL-097-013
License Number StateNC

VIII. Authorized Official

Name: FRED H LEONARD
Title or Position: PRESIDENT
Credential: MS
Phone: 828-659-3418