Provider Demographics
NPI:1720013774
Name:HEALTH WISE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:HEALTH WISE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-569-9473
Mailing Address - Street 1:17401 WEST 12MILE RD
Mailing Address - Street 2:STE A
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2135
Mailing Address - Country:US
Mailing Address - Phone:248-569-9473
Mailing Address - Fax:248-569-9577
Practice Address - Street 1:17401 WEST 12 MILE RD
Practice Address - Street 2:STE A
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2135
Practice Address - Country:US
Practice Address - Phone:248-569-9473
Practice Address - Fax:248-569-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15-4567408Medicaid
OE961OtherBCBS
237485Medicare ID - Type Unspecified