Provider Demographics
NPI:1457357048
Name:COUNTY OF WILSON
Entity Type:Organization
Organization Name:COUNTY OF WILSON
Other - Org Name:WILSON COUNTY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-237-4335
Mailing Address - Street 1:1801 GLENDALE DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4401
Mailing Address - Country:US
Mailing Address - Phone:252-237-4335
Mailing Address - Fax:252-293-8302
Practice Address - Street 1:1801 GLENDALE DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4401
Practice Address - Country:US
Practice Address - Phone:252-237-4335
Practice Address - Fax:252-293-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0343251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600230OtherPERSONAL CARE PROVIDER NU
NC3407019Medicaid
NC6600230OtherPERSONAL CARE PROVIDER NU
NC6600230OtherPERSONAL CARE PROVIDER NU