Provider Demographics
NPI:1902959133
Name:WILKERSON HEALTH CARE
Entity Type:Organization
Organization Name:WILKERSON HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-677-7759
Mailing Address - Street 1:1770 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2625
Mailing Address - Country:US
Mailing Address - Phone:636-677-7759
Mailing Address - Fax:636-677-3834
Practice Address - Street 1:1770 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2625
Practice Address - Country:US
Practice Address - Phone:636-677-7759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0003794251K00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1689709164Medicaid
MO289790206Medicaid
MO1902959133Medicaid
MO269790200Medicaid