Provider Demographics
NPI:1265970628
Name:PATRICIA WILSON HOME HEALTH LLC
Entity type:Organization
Organization Name:PATRICIA WILSON HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-760-7103
Mailing Address - Street 1:9746 HARLINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533
Mailing Address - Country:US
Mailing Address - Phone:850-760-7103
Mailing Address - Fax:850-857-1976
Practice Address - Street 1:9746 HARLINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-4530
Practice Address - Country:US
Practice Address - Phone:850-760-7103
Practice Address - Fax:850-857-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health