Provider Demographics
NPI:1437224151
Name:WILSON COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity Type:Organization
Organization Name:WILSON COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-206-4218
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:100 GOLD STREET
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27894-0459
Mailing Address - Country:US
Mailing Address - Phone:252-206-4010
Mailing Address - Fax:252-206-4028
Practice Address - Street 1:100 GOLD ST NE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27894-0459
Practice Address - Country:US
Practice Address - Phone:252-206-4010
Practice Address - Fax:252-206-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8700056251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700056Medicaid