Provider Demographics
NPI:1629093026
Name:WILSON'S HOME CARE AGENCY, INC.
Entity Type:Organization
Organization Name:WILSON'S HOME CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-244-3595
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:VANCEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28586-1022
Mailing Address - Country:US
Mailing Address - Phone:252-244-3595
Mailing Address - Fax:252-244-3163
Practice Address - Street 1:7914 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586-1022
Practice Address - Country:US
Practice Address - Phone:252-244-3595
Practice Address - Fax:252-244-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1762251E00000X, 3747P1801X
NCHC20673747P1801X
NCHC21703747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409088Medicaid
NC6600834Medicaid
NC6600625Medicaid
NC6600785Medicaid