Provider Demographics
NPI:1740417310
Name:MISSIONHOSPITALS
Entity Type:Organization
Organization Name:MISSIONHOSPITALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEROLINE
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:WOMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-213-4054
Mailing Address - Street 1:428 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:428 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4502
Practice Address - Country:US
Practice Address - Phone:828-213-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC002994283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital