Provider Demographics
NPI:1558531517
Name:WESLEY SHELTER, INC.
Entity Type:Organization
Organization Name:WESLEY SHELTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR OF BOARD OF DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-291-2344
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27894-1426
Mailing Address - Country:US
Mailing Address - Phone:252-291-2344
Mailing Address - Fax:
Practice Address - Street 1:106 VANCE ST E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4034
Practice Address - Country:US
Practice Address - Phone:252-291-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty