Provider Demographics
NPI:1548793771
Name:THE WISDOM WAY LLC
Entity Type:Organization
Organization Name:THE WISDOM WAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-298-4332
Mailing Address - Street 1:150 E PALMETTO PARK RD STE 800
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4833
Mailing Address - Country:US
Mailing Address - Phone:954-298-4332
Mailing Address - Fax:561-465-7616
Practice Address - Street 1:150 E PALMETTO PARK RD STE 800
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4833
Practice Address - Country:US
Practice Address - Phone:954-298-4332
Practice Address - Fax:561-465-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234707253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care