Healthcare Provider Details

I. General information

NPI: 1912902628
Provider Name (Legal Business Name): WILMED GENERATIONS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 TARBORO ST SW
WILSON NC
27893-3428
US

IV. Provider business mailing address

1705 TARBORO ST SW
WILSON NC
27893-3428
US

V. Phone/Fax

Practice location:
  • Phone: 252-399-8998
  • Fax: 252-399-8996
Mailing address:
  • Phone: 252-399-8998
  • Fax: 252-399-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0530
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3405423
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MRS. BETTY E. LANCASTER
Title or Position: ADMINISTRATOR
Credential: RN,BSN
Phone: 252-399-8998