Provider Demographics
NPI:1831914217
Name:WISELITE LLC
Entity type:Organization
Organization Name:WISELITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAMIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-732-4362
Mailing Address - Street 1:103 NELSON HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-2022
Mailing Address - Country:US
Mailing Address - Phone:757-732-4362
Mailing Address - Fax:
Practice Address - Street 1:103 NELSON HOUSE LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2022
Practice Address - Country:US
Practice Address - Phone:757-732-4362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty