Provider Demographics
NPI:1225254006
Name:WILSON COUNTY RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:WILSON COUNTY RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-237-4778
Mailing Address - Street 1:115B HINES ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3924
Mailing Address - Country:US
Mailing Address - Phone:252-237-4778
Mailing Address - Fax:252-206-1681
Practice Address - Street 1:115B HINES ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3924
Practice Address - Country:US
Practice Address - Phone:252-237-4778
Practice Address - Fax:252-206-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCWG000151OtherSCATTERED SITES