Provider Demographics
NPI:1861653354
Name:EGDE WISE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:EGDE WISE ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-734-3516
Mailing Address - Street 1:1932 S LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5103
Mailing Address - Country:US
Mailing Address - Phone:972-771-3346
Mailing Address - Fax:
Practice Address - Street 1:1932 S LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5103
Practice Address - Country:US
Practice Address - Phone:972-771-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities