Provider Demographics
NPI:1639210735
Name:POLK VOCATIONAL SERVICES
Entity Type:Organization
Organization Name:POLK VOCATIONAL SERVICES
Other - Org Name:POLK COUNTY SHELTERED WORKSHOP DBA POLK VOCATIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PROGRAM SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-894-3041
Mailing Address - Street 1:451 INDUSTRIAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722
Mailing Address - Country:US
Mailing Address - Phone:828-894-3041
Mailing Address - Fax:828-894-3883
Practice Address - Street 1:451 INDUSTRIAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722
Practice Address - Country:US
Practice Address - Phone:828-894-3041
Practice Address - Fax:828-894-3883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLK COUNTY SHELTERED WORKSHOP DBA POLK VOCATIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408905Medicaid