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General NPI Number Information
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NPI Number | 1467731992
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Entity Type | Organization
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Legal Business Name | HAROLD WILSON
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 1235 NORTH LOOP W STE 1015
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City | HOUSTON
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State | TX
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Zip | 77008-4708
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Country | US
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Telephone | 832-245-8103
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1492
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City | CYPRESS
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State | TX
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Zip | 77410-1492
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Country | US
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Telephone | 832-245-8103
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. HAROLD EARL WILSON
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Credential |
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Telephone | 832-245-8103
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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 |
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