Healthcare Provider Details

I. General information

NPI: 1982246831
Provider Name (Legal Business Name): WISE CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 WASHBURN AVE STE 206
CHARLOTTE NC
28205-7163
US

IV. Provider business mailing address

3325 WASHBURN AVE STE 206
CHARLOTTE NC
28205-7163
US

V. Phone/Fax

Practice location:
  • Phone: 704-910-0395
  • Fax: 704-910-1414
Mailing address:
  • Phone: 704-910-0395
  • Fax: 704-910-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ONDEA LASHARAE SWAGGARD
Title or Position: OWNER
Credential:
Phone: 704-910-0395