Provider Demographics
NPI:1265556294
Name:WILKINSON CARE CENTER, INC.
Entity type:Organization
Organization Name:WILKINSON CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-998-5001
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-1678
Mailing Address - Country:US
Mailing Address - Phone:336-998-5001
Mailing Address - Fax:336-998-5470
Practice Address - Street 1:415 ELDERBERRY LN
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6369
Practice Address - Country:US
Practice Address - Phone:828-252-1790
Practice Address - Fax:828-649-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0479314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415319Medicaid
NC3405319Medicaid
NC3406576Medicaid
NC3405319Medicaid