MEDICARE: WNC MADISON COUNTY HOUSING CORP

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	MHL057014	NC
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972650612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WNC MADISON COUNTY HOUSING CORP

Provider Business Mailing Address
First Line	:	PO BOX 97
Second Line	:
City	:	HOT SPRINGS
State	:	NC
Zip	:	28743-0097
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 MOUNTAIN HEIGHTS AVE
Second Line	:
City	:	HOT SPRINGS
State	:	NC
Zip	:	28743
Country	:	US
Telephone Number	:	828-622-3332
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BARBARA WRENN
Credential	:
Telephone Number	:	828-622-3332

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	06/27/2011

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