Provider Demographics
NPI:1831837590
Name:WISE AUTISM INC
Entity type:Organization
Organization Name:WISE AUTISM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFICARE
Authorized Official - Phone:651-223-9868
Mailing Address - Street 1:1117 MARQUETTE AVE APT 1308
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2499
Mailing Address - Country:US
Mailing Address - Phone:651-223-9868
Mailing Address - Fax:
Practice Address - Street 1:1117 MARQUETTE AVE APT 1308
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2499
Practice Address - Country:US
Practice Address - Phone:651-223-9868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services