Healthcare Provider Details

I. General information

NPI: 1609193341
Provider Name (Legal Business Name): WILANDLO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S WASHINGTON AVE SUITE 202
SAGINAW MI
48607-1152
US

IV. Provider business mailing address

320 S WASHINGTON AVE SUITE 202
SAGINAW MI
48607-1152
US

V. Phone/Fax

Practice location:
  • Phone: 989-752-5501
  • Fax: 989-752-5503
Mailing address:
  • Phone: 989-752-5501
  • Fax: 989-752-5503

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: WILBERT J. SMITH
Title or Position: PRESIDENT
Credential:
Phone: 989-752-5501