Provider Demographics
NPI:1982106159
Name:WILKINSON COMMUNITY OUTREACH
Entity Type:Organization
Organization Name:WILKINSON COMMUNITY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-429-0119
Mailing Address - Street 1:18314 S I 12 SERVICE RD STE B
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-4710
Mailing Address - Country:US
Mailing Address - Phone:985-429-0119
Mailing Address - Fax:
Practice Address - Street 1:1305 DEREK DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5717
Practice Address - Country:US
Practice Address - Phone:985-542-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKINSON CARE GIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203782738251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services