Provider Demographics
NPI:1073731246
Name:WILKES VOCATIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:WILKES VOCATIONAL SERVICES, INC.
Other - Org Name:WILKES COUNTY VOCATIONAL WORKSHOP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGRADY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:336-838-3812
Mailing Address - Street 1:501 ELKIN HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3457
Mailing Address - Country:US
Mailing Address - Phone:336-838-3812
Mailing Address - Fax:336-667-1045
Practice Address - Street 1:501 ELKIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3457
Practice Address - Country:US
Practice Address - Phone:336-838-3812
Practice Address - Fax:336-667-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NCNR8464251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301524Medicaid