NPIMap

Organization Active NPI

Wilson County Residential Services, Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Wilson, NC
National Provider Identifier
1750453098
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-098-080 Issued in NC
Legal business name
WILSON COUNTY RESIDENTIAL SERVICES, INC
Practice address
308 Bragg St NE
Group Home#1
Wilson, NC 27893-3202
Phone
(252) 243-3022
Fax
(252) 206-1681
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Gale Purvis
Title
Executive Director
Phone
(252) 237-4778

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-098-080 NC Primary

Addresses

Primary practice location

308 Bragg St NE
Group Home#1
Wilson, NC 27893-3202

Mailing address

115 Hines St W
Unite B
Wilson, NC 27893-3924
Phone (252) 237-4778

Other identifiers 1

IdentifierTypeStateIssuer
7804388MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Wilson County Residential Services8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750453098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 HINES ST W",
            "address_2": "UNITE B",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278933924",
            "telephone_number": "252-237-4778",
            "fax_number": "252-206-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 BRAGG ST NE",
            "address_2": "GROUP HOME#1",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278933202",
            "telephone_number": "252-243-3022",
            "fax_number": "252-206-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON COUNTY RESIDENTIAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PURVIS",
        "authorized_official_first_name": "GALE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "252-237-4778",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-098-080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804388",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.