Provider Demographics
NPI:1578901872
Name:WKJ UNLIMITED, LLC
Entity Type:Organization
Organization Name:WKJ UNLIMITED, LLC
Other - Org Name:WOLFEPAC HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KARIM
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-229-3824
Mailing Address - Street 1:637 ROCK LAKE GLN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-0001
Mailing Address - Country:US
Mailing Address - Phone:980-229-3824
Mailing Address - Fax:
Practice Address - Street 1:637 ROCK LAKE GLN
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-0001
Practice Address - Country:US
Practice Address - Phone:980-229-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health