Healthcare Provider Details

I. General information

NPI: 1457174203
Provider Name (Legal Business Name): HEALWISE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 DOGWOOD ST
UPLAND CA
91784-7359
US

IV. Provider business mailing address

1235 DOGWOOD ST
UPLAND CA
91784-7359
US

V. Phone/Fax

Practice location:
  • Phone: 626-215-3583
  • Fax:
Mailing address:
  • Phone: 626-215-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID LIU
Title or Position: PRESIDENT
Credential:
Phone: 626-215-3583