IndividualActive
Crystal Wilson
NPI 1477279446 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Shade, OH
Provider details
- NPI number
- 1477279446
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
40328 Burlingham Rd
Shade, OH 45776-9505
Phone: (740) 590-9205
Approximate (ZIP-level) locationGet directions
Mailing address
40328 Burlingham Rd
Shade, OH 45776-9505
Registry dates
- Enumerated
- 2022-10-12
- Last updated
- 2022-10-12
- Certified
- 2022-10-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.