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1815 Forest Hills Rd W Wilson NC 27893-3412 | |
| (252) 243-0100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | In Home Supportive Care |
| Location | 1815 Forest Hills Rd W, Wilson, North Carolina |
| Authorized Official Name and Position | Etanya Lucas (PRESIDENT/CEO) |
| Authorized Official Contact | 9194384844 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1209 Justin Ln Lithonia GA 30058-8256 Ph: () - | 1815 Forest Hills Rd W Wilson NC 27893-3412 Ph: (252) 243-0100 |
| NPI Number | 1841534070 |
|---|---|
| Provider Enumeration Date | 11/09/2012 |
| Last Update Date | 01/12/2023 |
| Certification Date | 01/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841534070 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL-098-182 (North Carolina) | Secondary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Primary |
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