Healthcare Provider Details

I. General information

NPI: 1861008559
Provider Name (Legal Business Name): MRS. SARAH GENEVIEVE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 JEFFERSON AVE
CINCINNATI OH
45246-4329
US

IV. Provider business mailing address

484 DOROTHY LN
SPRINGDALE OH
45246-2228
US

V. Phone/Fax

Practice location:
  • Phone: 513-213-8899
  • Fax:
Mailing address:
  • Phone: 513-213-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: