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General NPI Number Information
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NPI Number | 1437211760
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Entity Type | Organization
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Legal Business Name | WILSON HEALTHCARE, INC DBA SIERRA HOUSE
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12632 206TH ST
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City | LAKEWOOD
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State | CA
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Zip | 90715-1902
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Country | US
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Telephone | 562-809-0042
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 CALLE JUCA DR
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City | LA HABRA HEIGHTS
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State | CA
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Zip | 90631-8654
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARK F. WILSON
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Credential |
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Telephone | 562-809-0042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | CA
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