MEDICARE: WILSON'S HOME HEALTH CRE

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	251E00000X	Home Health Agency		FL

General Provider Information

NPI Number	:	1811374317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON'S HOME HEALTH CRE

Provider Business Mailing Address
First Line	:	1203 S 33RD ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-6300
Country	:	US
Telephone Number	:	772-672-0427
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 S 33RD ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-6300
Country	:	US
Telephone Number	:	772-672-0427
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. COMESHA MICHELLE WILSON
Credential	:
Telephone Number	:	772-672-0427

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	07/21/2022

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