Provider Demographics
NPI:1912902628
Name:WILMED GENERATIONS,INC.
Entity type:Organization
Organization Name:WILMED GENERATIONS,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:252-399-8998
Mailing Address - Street 1:1705 TARBORO ST SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3428
Mailing Address - Country:US
Mailing Address - Phone:252-399-8998
Mailing Address - Fax:252-399-8996
Practice Address - Street 1:1705 TARBORO ST SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3428
Practice Address - Country:US
Practice Address - Phone:252-399-8998
Practice Address - Fax:252-399-8996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON MEDICAL CENTER,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-17
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0530314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405423Medicaid
NC345423Medicare ID - Type Unspecified