Provider Demographics
NPI:1699238980
Name:WILSON'S RESIDENTIAL HOMES, LLC
Entity type:Organization
Organization Name:WILSON'S RESIDENTIAL HOMES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KORTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-857-5442
Mailing Address - Street 1:218 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4554
Mailing Address - Country:US
Mailing Address - Phone:434-857-5442
Mailing Address - Fax:434-857-5442
Practice Address - Street 1:152 NEW ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-3827
Practice Address - Country:US
Practice Address - Phone:434-853-2057
Practice Address - Fax:434-857-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities