Healthcare Provider Details

I. General information

NPI: 1962314690
Provider Name (Legal Business Name): WILSON IN HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 KAPIOLANI BLVD STE 450
HONOLULU HI
96813-5299
US

IV. Provider business mailing address

711 KAPIOLANI BLVD STE 450
HONOLULU HI
96813-5299
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-4486
  • Fax: 808-356-1531
Mailing address:
  • Phone: 808-596-4486
  • Fax: 808-356-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY WILSON
Title or Position: OWNER
Credential:
Phone: 808-596-4486