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General NPI Number Information
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NPI Number | 1093012270
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Entity Type | Organization
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Legal Business Name | WILSON ELITE SERVICES, LLC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 1634 SW THELMA ST
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City | PALM CITY
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State | FL
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Zip | 34990-3361
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Country | US
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Telephone | 772-214-4559
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Fax | 772-286-4992
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Provider Business Mailing Address
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Address Line | 1634 SW THELMA ST
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City | PALM CITY
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State | FL
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Zip | 34990-3361
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Country | US
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Telephone | 772-214-4559
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Fax | 772-286-4992
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. VIOLA WILSON
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Credential |
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Telephone | 772-286-4982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 691506098
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 691506096
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License Number State | FL
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