Individual
LATOYA RENEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CEO
Contact information
Practice address
4114 N IRVINGTON AVE, INDIANAPOLIS, IN 46226-4772
(317) 200-6078
Mailing address
4114 N IRVINGTON AVE, INDIANAPOLIS, IN 46226-4772
(317) 200-6078
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
24-017002-1
IN
372600000X
Adult Companion
24-017002-1
IN
3747P1801X
Personal Care Attendant
24-017002-1
IN
376J00000X
Homemaker
24-017002-1
IN
Other
Enumeration date
07/16/2024
Last updated
07/27/2024
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