MEDICARE: BILL WILSON CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1134577927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BILL WILSON CENTER

Provider Business Mailing Address
First Line	:	PO BOX 127
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94559-0127
Country	:	US
Telephone Number	:	707-255-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 N 2ND ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6317
Country	:	US
Telephone Number	:	408-278-2531
Fax Number	:	408-278-2531

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHERYL ROUSE
Credential	:
Telephone Number	:	408-278-2531

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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