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General NPI Number Information
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NPI Number | 1417196353
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Entity Type | Organization
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Legal Business Name | WILSON'S HOME CARE AGENCY
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 1528 SO EVAN ST. SIUTE M
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City | GREENVILLE
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State | NC
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Zip | 27834-5311
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Country | US
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Telephone | 252-353-8020
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Fax | 252-353-8040
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Provider Business Mailing Address
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Address Line | 7914 MAIN ST. PO BOX 1022
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City | VANCEBORO
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State | NC
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Zip | 28586-1022
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Country | US
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Telephone | 252-244-3595
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Fax | 252-244-3163
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BRENDA ANN WIL;SON
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Credential | RN
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Telephone | 252-244-3595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | HC2170
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License Number State | NC
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