Healthcare Provider Details

I. General information

NPI: 1629817259
Provider Name (Legal Business Name): SALENA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 LEE RD STE 105
SHAKER HTS OH
44120-5139
US

IV. Provider business mailing address

1224 SHARONBROOK DR
TWINSBURG OH
44087-2754
US

V. Phone/Fax

Practice location:
  • Phone: 216-387-6896
  • Fax:
Mailing address:
  • Phone: 216-387-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number401846720416
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: