Provider Demographics
NPI:1114016896
Name:THREE WISHES INC
Entity Type:Organization
Organization Name:THREE WISHES INC
Other - Org Name:THREE WISHES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-535-3063
Mailing Address - Street 1:2390 CRENSHAW BLVD
Mailing Address - Street 2:#128
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3300
Mailing Address - Country:US
Mailing Address - Phone:800-535-3063
Mailing Address - Fax:800-270-8102
Practice Address - Street 1:43084 RANCHO WAY
Practice Address - Street 2:SUITE B
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3487
Practice Address - Country:US
Practice Address - Phone:951-694-8708
Practice Address - Fax:951-694-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100452040AMedicaid
TN4582266Medicaid
ID806665400Medicaid
IN2003865804Medicaid
ID806665400Medicaid
IN2003865804Medicaid