Provider Demographics
NPI:1811600349
Name:WILSON ESTATE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:WILSON ESTATE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYMONE
Authorized Official - Middle Name:NICHOLE-MARIE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-873-8808
Mailing Address - Street 1:1821 W GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1821 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4848
Practice Address - Country:US
Practice Address - Phone:513-873-8808
Practice Address - Fax:513-873-8507
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON ESTATE HOME HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0416039Medicaid