Provider Demographics
NPI:1033684766
Name:WISH HEALTH SERVICES
Entity Type:Organization
Organization Name:WISH HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEIMYEREIA
Authorized Official - Middle Name:RAILYNN
Authorized Official - Last Name:LEWIS-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:504-518-6383
Mailing Address - Street 1:PO BOX 750423
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175-0423
Mailing Address - Country:US
Mailing Address - Phone:228-209-6307
Mailing Address - Fax:888-725-7090
Practice Address - Street 1:1520 29TH AVE STE 16
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2843
Practice Address - Country:US
Practice Address - Phone:228-209-6307
Practice Address - Fax:888-725-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child