Provider Demographics
NPI:1134638422
Name:WILSON HOME HEALTH SERVICE, LLC
Entity Type:Organization
Organization Name:WILSON HOME HEALTH SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LENNIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS
Authorized Official - Phone:757-277-2750
Mailing Address - Street 1:1015 TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-3634
Mailing Address - Country:US
Mailing Address - Phone:757-277-2750
Mailing Address - Fax:
Practice Address - Street 1:1015 TRUMAN RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-3634
Practice Address - Country:US
Practice Address - Phone:757-277-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities