Provider Demographics
NPI:1386228187
Name:MARSHA WILSON AT HOME RESIDENTIAL CARE
Entity Type:Organization
Organization Name:MARSHA WILSON AT HOME RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:ANTHIA
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CDP, MS-ED
Authorized Official - Phone:407-970-3909
Mailing Address - Street 1:1890 LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3710
Mailing Address - Country:US
Mailing Address - Phone:407-970-3909
Mailing Address - Fax:407-201-5987
Practice Address - Street 1:1890 LEMON AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3710
Practice Address - Country:US
Practice Address - Phone:407-970-3909
Practice Address - Fax:407-201-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness