Provider Demographics
NPI:1295016681
Name:PREFERRED HOME AND HOSPICE CARE AND OPT PLLC
Entity Type:Organization
Organization Name:PREFERRED HOME AND HOSPICE CARE AND OPT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:C-FNP
Authorized Official - Phone:336-740-0897
Mailing Address - Street 1:401 TATE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-2523
Mailing Address - Country:US
Mailing Address - Phone:336-684-5330
Mailing Address - Fax:
Practice Address - Street 1:401 TATE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-2523
Practice Address - Country:US
Practice Address - Phone:336-740-0897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00418200305R00000X
MDR127999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC123456OtherPENDING