Provider Demographics
NPI:1205382751
Name:WILLGLO SERVICES, INC
Entity Type:Organization
Organization Name:WILLGLO SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BURGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-443-3020
Mailing Address - Street 1:PO BOX 77469
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-7469
Mailing Address - Country:US
Mailing Address - Phone:614-443-3020
Mailing Address - Fax:614-443-2920
Practice Address - Street 1:995 THURMAN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-3133
Practice Address - Country:US
Practice Address - Phone:614-443-3020
Practice Address - Fax:614-443-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2507433Medicaid