Provider Demographics
NPI:1194561332
Name:WISH HOME CARE LLC
Entity type:Organization
Organization Name:WISH HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHOWMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-986-2986
Mailing Address - Street 1:11350 RANDOM HILLS RD STE 874
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6044
Mailing Address - Country:US
Mailing Address - Phone:610-986-2986
Mailing Address - Fax:
Practice Address - Street 1:11350 RANDOM HILLS RD STE 874
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6044
Practice Address - Country:US
Practice Address - Phone:610-986-2986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care