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General NPI Number Information
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NPI Number | 1699238980
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Entity Type | Organization
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Legal Business Name | WILSON'S RESIDENTIAL HOMES, LLC
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 152 NEW ST
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City | DANVILLE
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State | VA
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Zip | 24540-3827
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Country | US
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Telephone | 434-853-2057
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Fax | 434-857-5442
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Provider Business Mailing Address
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Address Line | 218 TYLER AVE
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City | DANVILLE
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State | VA
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Zip | 24541-4554
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Country | US
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Telephone | 434-857-5442
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Fax | 434-857-5442
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Authorized Official
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Title or Position | CEO
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Name | KORTNEY WILSON
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Credential |
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Telephone | 434-380-2424
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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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