Healthcare Provider Details

I. General information

NPI: 1154666840
Provider Name (Legal Business Name): WISDOM CARE & CONSULTING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 PLAINFIELD RD SUITE 203
WILLOWBROOK IL
60527-5343
US

IV. Provider business mailing address

621 PLAINFIELD RD SUITE 203
WILLOWBROOK IL
60527-5343
US

V. Phone/Fax

Practice location:
  • Phone: 630-568-5047
  • Fax:
Mailing address:
  • Phone: 630-568-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4000393
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000940
License Number StateIL

VIII. Authorized Official

Name: MRS. SALLY A NWAFOR
Title or Position: CEO
Credential: RN MSN
Phone: 773-320-3199