Provider Demographics
NPI:1306888029
Name:WISDOM HEALTH CARE SERVICES INC.
Entity type:Organization
Organization Name:WISDOM HEALTH CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:DICHE
Authorized Official - Last Name:IBEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHN, BSN
Authorized Official - Phone:310-324-3290
Mailing Address - Street 1:16921 S WESTERN AVE
Mailing Address - Street 2:#219
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5248
Mailing Address - Country:US
Mailing Address - Phone:310-324-3290
Mailing Address - Fax:310-324-3614
Practice Address - Street 1:16921 S WESTERN AVE
Practice Address - Street 2:#219
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-5248
Practice Address - Country:US
Practice Address - Phone:310-324-3290
Practice Address - Fax:310-324-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health