Provider Demographics
NPI:1033321948
Name:SUPPORT CARE
Entity type:Organization
Organization Name:SUPPORT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:EGBE
Authorized Official - Last Name:TABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-735-3311
Mailing Address - Street 1:1216 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1858
Mailing Address - Country:US
Mailing Address - Phone:919-734-4420
Mailing Address - Fax:919-735-1568
Practice Address - Street 1:1402 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2252
Practice Address - Country:US
Practice Address - Phone:919-735-3311
Practice Address - Fax:919-735-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-096-1933104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness