Provider Demographics
NPI:1922633759
Name:WISE CHOICE HOME CARE LLC
Entity Type:Organization
Organization Name:WISE CHOICE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-890-4310
Mailing Address - Street 1:4383 ROBINSON LOOP E
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6787
Mailing Address - Country:US
Mailing Address - Phone:901-303-4695
Mailing Address - Fax:662-890-4514
Practice Address - Street 1:9135 HIGHWAY 178
Practice Address - Street 2:STE A
Practice Address - City:EAST OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3865
Practice Address - Country:US
Practice Address - Phone:322-890-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care