Provider Demographics
NPI:1962210864
Name:WISH GRANTED
Entity type:Organization
Organization Name:WISH GRANTED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-525-3578
Mailing Address - Street 1:910 GLENBROOK CIR APT A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1670
Mailing Address - Country:US
Mailing Address - Phone:810-525-3578
Mailing Address - Fax:
Practice Address - Street 1:910 GLENBROOK CIRCLE
Practice Address - Street 2:A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-525-3578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WISH GRANTED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-23
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health