Provider Demographics
NPI:1306201181
Name:WISDOM ONE LLC
Entity Type:Organization
Organization Name:WISDOM ONE LLC
Other - Org Name:WISDOM ONE HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKEH
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:202-836-4857
Mailing Address - Street 1:7603 GEORGIA AVE NW STE 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1617
Mailing Address - Country:US
Mailing Address - Phone:202-836-4857
Mailing Address - Fax:202-836-4859
Practice Address - Street 1:7603 GEORGIA AVE NW STE 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1617
Practice Address - Country:US
Practice Address - Phone:202-836-4857
Practice Address - Fax:202-836-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care