Provider Demographics
NPI:1528606225
Name:WILKESBORO HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:WILKESBORO HEALTH AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SPRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-608-9123
Mailing Address - Street 1:229 AIRPORT RD STE 7-104
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-6402
Mailing Address - Country:US
Mailing Address - Phone:919-608-9123
Mailing Address - Fax:
Practice Address - Street 1:204 OLD BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-8971
Practice Address - Country:US
Practice Address - Phone:336-667-2020
Practice Address - Fax:336-667-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNH0509Medicaid