Provider Demographics
NPI:1386976975
Name:PD OF WILMINGTON INC
Entity type:Organization
Organization Name:PD OF WILMINGTON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:CAMARET
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-395-5440
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480-0539
Mailing Address - Country:US
Mailing Address - Phone:910-395-5440
Mailing Address - Fax:
Practice Address - Street 1:100 B THE EASTWOOD CENTER
Practice Address - Street 2:STE 33
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0504
Practice Address - Country:US
Practice Address - Phone:910-395-5440
Practice Address - Fax:910-395-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3938253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care