Individual
KHAIYANA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5508 PEARL ST, PHILADELPHIA, PA 19139-2027
(267) 226-4557
(267) 367-5656
Mailing address
7244 CASTOR AVE # 1866, PHILADELPHIA, PA 19149-1109
(267) 452-2386
(267) 367-5656
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
374U00000X
Home Health Aide
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
01/19/2024
Last updated
01/22/2024
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