Provider Demographics
NPI:1417771551
Name:WATCH INTERNATIONAL FOR THE SECURITY OF HUMANITY (THE WISH CENTER)
Entity type:Organization
Organization Name:WATCH INTERNATIONAL FOR THE SECURITY OF HUMANITY (THE WISH CENTER)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:REMIE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:763-447-1063
Mailing Address - Street 1:6248 LAKELAND AVE N STE 210
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2989
Mailing Address - Country:US
Mailing Address - Phone:763-447-1063
Mailing Address - Fax:
Practice Address - Street 1:6248 LAKELAND AVE N STE 210
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55428-2989
Practice Address - Country:US
Practice Address - Phone:763-447-1063
Practice Address - Fax:763-592-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty