Organization
WILSON COUNTY RESIDENTIAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GALE PURVIS (EXECUTIVE DIRECTOR)
(252) 237-4778
Entity
Organization
Contact information
Practice address
308 BRAGG ST NE, GROUP HOME#1, WILSON, NC 27893-3202
(252) 243-3022
(252) 206-1681
Mailing address
115 HINES ST W, UNITE B, WILSON, NC 27893-3924
(252) 237-4778
(252) 206-1681
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-098-080
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804388
—
NC
Enumeration date
11/14/2006
Last updated
08/22/2020
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