MEDICARE: WILKES ADULT DEVELOPMENTAL ACTIVITY PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		NC

General Provider Information

NPI Number	:	1831208875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILKES ADULT DEVELOPMENTAL ACTIVITY PROGRAM

Provider Business Mailing Address
First Line	:	PO BOX 968
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-0968
Country	:	US
Telephone Number	:	336-667-1800
Fax Number	:	336-667-0694

Provider Business Practice Location Address
First Line	:	902 BOSTON AVENUE
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-0968
Country	:	US
Telephone Number	:	336-667-1800
Fax Number	:	336-667-0694

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. ROBIN B. WHITTINGTON
Credential	:
Telephone Number	:	336-667-1800

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/21/2022

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