Provider Demographics
NPI:1316118789
Name:WISE & HEALTHY AGING
Entity type:Organization
Organization Name:WISE & HEALTHY AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-394-9871
Mailing Address - Street 1:1527 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2358
Mailing Address - Country:US
Mailing Address - Phone:310-394-9871
Mailing Address - Fax:310-576-2449
Practice Address - Street 1:1527 4TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2358
Practice Address - Country:US
Practice Address - Phone:310-394-9871
Practice Address - Fax:310-395-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty