Provider Demographics
NPI:1881681963
Name:WISDOM HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:WISDOM HOME HEALTH CARE INC
Other - Org Name:FIRST IN CARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-940-7365
Mailing Address - Street 1:509 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4875
Mailing Address - Country:US
Mailing Address - Phone:281-940-7365
Mailing Address - Fax:866-691-3181
Practice Address - Street 1:509 S WASHINGTON AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4875
Practice Address - Country:US
Practice Address - Phone:281-940-7365
Practice Address - Fax:866-691-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009230251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009230OtherSTATE LICENSE
TX457837Medicare ID - Type Unspecified