Healthcare Provider Details

I. General information

NPI: 1205382751
Provider Name (Legal Business Name): WILLGLO SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 THURMAN AVE
COLUMBUS OH
43206-3133
US

IV. Provider business mailing address

PO BOX 77469
COLUMBUS OH
43207-7469
US

V. Phone/Fax

Practice location:
  • Phone: 614-443-3020
  • Fax: 614-443-2920
Mailing address:
  • Phone: 614-443-3020
  • Fax: 614-443-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM JAMES BURGE
Title or Position: ADMINISTRATOR
Credential:
Phone: 614-443-3020