Healthcare Provider Details

I. General information

NPI: 1306888029
Provider Name (Legal Business Name): WISDOM HEALTH CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16921 S WESTERN AVE #219
GARDENA CA
90247-5248
US

IV. Provider business mailing address

16921 S WESTERN AVE #219
GARDENA CA
90247-5248
US

V. Phone/Fax

Practice location:
  • Phone: 310-324-3290
  • Fax: 310-324-3614
Mailing address:
  • Phone: 310-324-3290
  • Fax: 310-324-3614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. AGATHA DICHE IBEKWE
Title or Position: PRESIDENT/CEO
Credential: RN, PHN, BSN
Phone: 310-324-3290