Provider Demographics
NPI:1275678567
Name:WILKES DAY CARE ASSOCIATION INC.
Entity Type:Organization
Organization Name:WILKES DAY CARE ASSOCIATION INC.
Other - Org Name:WILKES DEVELOPMENTAL DAY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-838-3119
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-0545
Mailing Address - Country:US
Mailing Address - Phone:336-838-3119
Mailing Address - Fax:336-667-6731
Practice Address - Street 1:1021 WELBORN AVE
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2223
Practice Address - Country:US
Practice Address - Phone:336-838-3119
Practice Address - Fax:336-667-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9755060251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300083KMedicaid
NC8300083Medicaid