Provider Demographics
NPI:1396097705
Name:WIMMS HEALTH CARE
Entity type:Organization
Organization Name:WIMMS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-268-8832
Mailing Address - Street 1:5385 WOODSIDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-9740
Mailing Address - Country:US
Mailing Address - Phone:231-268-8832
Mailing Address - Fax:
Practice Address - Street 1:5385 WOODSIDE PARK RD
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-9740
Practice Address - Country:US
Practice Address - Phone:231-268-8832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESIGN PROZ LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12-305251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0092644Medicaid