Provider Demographics
NPI:1063748218
Name:WISDOM HOME HEALTH AGENCY
Entity type:Organization
Organization Name:WISDOM HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-748-1014
Mailing Address - Street 1:2620 S PARKER RD
Mailing Address - Street 2:SUITE #160B
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1608
Mailing Address - Country:US
Mailing Address - Phone:720-748-1014
Mailing Address - Fax:
Practice Address - Street 1:2620 S PARKER RD
Practice Address - Street 2:SUITE #160B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1608
Practice Address - Country:US
Practice Address - Phone:720-748-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health