Provider Demographics
NPI:1053408286
Name:CARE PROVIDERS OF WILMINGTON
Entity type:Organization
Organization Name:CARE PROVIDERS OF WILMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASPER
Authorized Official - Middle Name:PERCELL
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:D ED
Authorized Official - Phone:910-254-9500
Mailing Address - Street 1:2527 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6000
Mailing Address - Country:US
Mailing Address - Phone:910-792-6296
Mailing Address - Fax:910-254-1492
Practice Address - Street 1:1612 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7406
Practice Address - Country:US
Practice Address - Phone:910-254-9500
Practice Address - Fax:910-254-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2343251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600998Medicaid
NC3408228Medicaid