Individual provider · Type 1 NPI
Ebony Wilson
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · St. Louis, MO
Practice location
3514 Blair Ave
St. Louis, MO 63107-3717
Mailing address
PO Box 24754
St. Louis, MO 63115-0654
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | None listed |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
Other intellectual and/or developmental disabilities community based residential treatment facility providers in St. Louis
About NPI 1013334622
Ebony Wilson's National Provider Identifier is 1013334622, issued on Mar 20, 2014. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in St. Louis, MO. The record was last updated on Mar 20, 2014.