Provider Demographics
NPI:1649318353
Name:WILKO ENTERPRISE
Entity type:Organization
Organization Name:WILKO ENTERPRISE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:254-298-8786
Mailing Address - Street 1:PO BOX 3689
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76505-3689
Mailing Address - Country:US
Mailing Address - Phone:254-298-8786
Mailing Address - Fax:254-298-8799
Practice Address - Street 1:19 N MAIN ST
Practice Address - Street 2:SUITE 2707
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7629
Practice Address - Country:US
Practice Address - Phone:254-298-8786
Practice Address - Fax:254-298-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011099251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679047Medicare Oscar/Certification