Provider Demographics
NPI:1811374317
Name:WILSON'S HOME HEALTH CRE
Entity type:Organization
Organization Name:WILSON'S HOME HEALTH CRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:COMESHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-672-0427
Mailing Address - Street 1:1203 S 33RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-6300
Mailing Address - Country:US
Mailing Address - Phone:772-672-0427
Mailing Address - Fax:
Practice Address - Street 1:1203 S 33RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-6300
Practice Address - Country:US
Practice Address - Phone:772-672-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health