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Crystal Rae Wilson
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Shade, Ohio
NPI 1477279446

Crystal Rae Wilson is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Shade, OH. Crystal Rae Wilson practices in Shade, OH. The NPI Number for Crystal Rae Wilson is 1477279446 and holds a License No. (Ohio).

The current practice location address for Crystal Rae Wilson is 40328 Burlingham Rd, Shade, OH and can be reached out via phone at 740-590-9205.

Location: 40328 Burlingham Rd, Shade, OH, 45776-9505
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1477279446
Provider Name
Crystal Rae Wilson
Credential
Provider Entity Type
Individual
Gender
Female
Address
40328 Burlingham Rd, Shade, OH, 45776-9505
Phone Number
740-590-9205
Fax Number
Provider Enumeration Date
10/12/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0000307788 05 OH
institution
Provider Business Practice Location Address Details
Address
40328 Burlingham Rd
City
Shade
State
Ohio
Zip
45776-9505
Phone Number
740-590-9205
Fax Number
person
Provider Business Mailing Address Details
Address
40328 Burlingham Rd
City
Shade
State
Ohio
Zip
45776-9505
Phone Number
740-590-9205
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
(Ohio)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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