Provider Demographics
NPI:1003148388
Name:ROBBIE WILSON COMMUNITY SERVICE INC
Entity Type:Organization
Organization Name:ROBBIE WILSON COMMUNITY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EYVETTE
Authorized Official - Middle Name:LACHELLA
Authorized Official - Last Name:AABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-473-9933
Mailing Address - Street 1:5462 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-1782
Mailing Address - Country:US
Mailing Address - Phone:336-473-9933
Mailing Address - Fax:
Practice Address - Street 1:5462 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-1782
Practice Address - Country:US
Practice Address - Phone:336-473-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
372500000X, 372600000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty