EBONY WILSON (NPI# 1013334622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013334622 |
| Entity Type | Individual |
| Full Name | EBONY WILSON |
| Practice Address |
3514 Blair Ave Saint Louis MO 63107-3717 |
| Mailing Address |
Po Box 24754 Saint Louis MO 63115-0654 |
| Practice Telephone | 3142160088 |
| Mailing Telephone | 3142160088 |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2014-03-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073156063 | Ebony N Wilson | Social Worker | 183 Iredell Ave, Troutman, NC 28166 | 2019-10-22 |
| 1023536463 | Ebony N Wilson | Counselor | 185 E. Elm St, #2057, Torrington, CT 06790-3726 | 2017-09-06 |
| 1063628667 | Ebony Star Wilson | Case Manager/Care Coordinator | 1704 Hwy 69, Truman, AR 72472 | 2007-05-14 |
| 1346744877 | Ebony Wilson | Behavior Technician | 1133 13th St, Columbus, GA 31901-2248 | 2018-03-20 |
| 1023475548 | Ebony Wilson | Social Worker | 622 Riverside Dr, Monroe, LA 71201-6211 | 2016-01-28 |
| Street Address |
3514 BLAIR AVE |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63107-3717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851937676 | Elizabeth Lawton | Counselor | Elizabeth Lawton, 4220 North Grand Boulevard, Saint Louis, MO 63107 | 2019-11-27 |
| 1518486885 | Sunflower Podiatry and Wellness | Podiatrist | 1316 Hebert Street, Saint Louis, MO 63107 | 2017-09-18 |
| 1609328996 | Gina Lagarce | Contractor | 801 N. 11th Street, St. Louis Public Schools, Saint Louis, MO 63107 | 2016-11-02 |
| 1932515012 | Christopher L Adams | Counselor | 4220 North Grand Blvd, St.louis, MO 63107 | 2014-07-09 |
| 1902212160 | Nora Ann Boland II | Counselor | 4220 North Grand Blvd., St. Louis, MO 63107 | 2014-07-09 |
| 1700209467 | Calvin Garner | Social Worker | 7018 Destrehan, St Louis, MO 63107 | 2014-01-30 |
| 1225464001 | Spring Manor LLC | Assisted Living Facility | 3610 Palm St., Apt/suite, Saint Louis, MO 63107 | 2013-09-24 |
| 1518189141 | Excel Home Health Care | Chore Provider | 2125 Bissell St, St. Louis, MO 63107 | 2007-05-03 |
| 1407375314 | Shayla Dana Smith | Counselor | 4220 Grand Ave, St Louis, MO 63107 | 2017-09-12 |
| 1528468147 | Annette Michelle Cook | Counselor | 4218 North Grand Blvd, St. Louis, MO 63107 | 2014-09-02 |
| Find all providers in zip 63107 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588108336 | Wright Way Residential Living | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2115 Allen Ave, Apt A, Saint Louis, MO 63104-2630 | 2016-12-13 |
| 1952768889 | Living With Purpose | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3919 N 19th St, Saint Louis, MO 63107-2816 | 2016-01-22 |
| 1154788156 | Promise Mobility LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5 S Newstead Ave, Saint Louis, MO 63108-2213 | 2016-01-21 |
| 1871914515 | Donald Scales | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8543 Jane Ave, Saint Louis, MO 63121-4309 | 2013-12-24 |
| 1609218593 | Young Mens Christian Association of Greater St Louis | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1528 Locust St, Saint Louis, MO 63103-1816 | 2013-07-22 |
| 1467894535 | Sun Valley Adult Care Center, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1000 Saint Cyr Rd, Saint Louis, MO 63137-1733 | 2013-07-18 |
| 1477802957 | Phillips Professional Home Health Service | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8456 A Page Ave, Saint Louis, MO 63130-1055 | 2012-08-30 |
| 1013283373 | Mers/missouri Goodwill Industries | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1727 Locust St, Saint Louis, MO 63103-1703 | 2012-03-30 |
| 1720359961 | Bethesda Lutheran Communities Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5122 Amberglow Dr, Saint Louis, MO 63129-3204 | 2012-01-19 |
| 1356662910 | Calista E. Melkersman | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4635 Frankfort Ave, Saint Louis, MO 63123-5832 | 2010-06-17 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.