Provider Demographics
NPI:1467731992
Name:HAROLD WILSON
Entity Type:Organization
Organization Name:HAROLD WILSON
Other - Org Name:ADVANCED HCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-245-8103
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-1492
Mailing Address - Country:US
Mailing Address - Phone:832-245-8103
Mailing Address - Fax:
Practice Address - Street 1:1235 NORTH LOOP W STE 1015
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4708
Practice Address - Country:US
Practice Address - Phone:832-245-8103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities