Provider Demographics
NPI:1093929739
Name:TJWANA WILSON
Entity Type:Organization
Organization Name:TJWANA WILSON
Other - Org Name:WILSON FAMILY CARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TJWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-859-8672
Mailing Address - Street 1:4600 HIGHWAY 6 N
Mailing Address - Street 2:STE 270
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2884
Mailing Address - Country:US
Mailing Address - Phone:281-859-8672
Mailing Address - Fax:
Practice Address - Street 1:4600 HIGHWAY 6 N
Practice Address - Street 2:STE 270
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2884
Practice Address - Country:US
Practice Address - Phone:281-859-8672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities