Provider Demographics
NPI:1992149629
Name:WILBURN HEALTHCARE MANAGEMENT SERVICES
Entity type:Organization
Organization Name:WILBURN HEALTHCARE MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKADAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-265-6089
Mailing Address - Street 1:PO BOX 91288
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77291-1288
Mailing Address - Country:US
Mailing Address - Phone:800-265-6089
Mailing Address - Fax:
Practice Address - Street 1:737 HIGHWAY 6 FM 520
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084
Practice Address - Country:US
Practice Address - Phone:800-265-6089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty