Organization
WILSON RESIDENTIAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MICHAEL WILSON (ADMINISTRATOR)
(330) 224-1041
Entity
Organization
Contact information
Practice address
6815 WILLIAM TELL AVE NW, NORTH CANTON, OH 44720-6547
(330) 224-1041
Mailing address
6815 WILLIAM TELL AVE NW, NORTH CANTON, OH 44720-6547
(330) 224-1041
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
7600804
OH
Other
Enumeration date
03/29/2007
Last updated
08/22/2020
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