Provider Demographics
NPI:1295783330
Name:WISE CHOICE HOME HEALTH INC.
Entity type:Organization
Organization Name:WISE CHOICE HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:276-328-7062
Mailing Address - Street 1:PO BOX 2499
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-2499
Mailing Address - Country:US
Mailing Address - Phone:276-328-7062
Mailing Address - Fax:276-328-7065
Practice Address - Street 1:511 WEST MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293
Practice Address - Country:US
Practice Address - Phone:276-328-7062
Practice Address - Fax:276-328-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO07387251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497622Medicare ID - Type UnspecifiedHOME HEALTH MEDICARE CERT