Provider Demographics
NPI:1801320395
Name:HISC WELLNESS 360
Entity type:Organization
Organization Name:HISC WELLNESS 360
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MP
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:301-452-2599
Mailing Address - Street 1:14001 TOLLISON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720
Mailing Address - Country:US
Mailing Address - Phone:301-452-2599
Mailing Address - Fax:
Practice Address - Street 1:14001 TOLLISON DRIVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720
Practice Address - Country:US
Practice Address - Phone:301-452-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management