Provider Demographics
NPI:1285727966
Name:WILSON IN HOME, INC.
Entity type:Organization
Organization Name:WILSON IN HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-596-4486
Mailing Address - Street 1:PO BOX 2058
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96805-2058
Mailing Address - Country:US
Mailing Address - Phone:808-596-4486
Mailing Address - Fax:808-596-4822
Practice Address - Street 1:711 KAPIOLANI BLVD STE 450
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5237
Practice Address - Country:US
Practice Address - Phone:808-596-4486
Practice Address - Fax:808-356-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI533473-01OtherMEDICAID EPSDT
HI505430-01Medicaid