Healthcare Provider Details

I. General information

NPI: 1043997067
Provider Name (Legal Business Name): WISE PROTECTIVE SERVICE AND MORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42713 WILMAR SQ
BROADLANDS VA
20148-4147
US

IV. Provider business mailing address

42713 WILMAR SQ
BROADLANDS VA
20148-4147
US

V. Phone/Fax

Practice location:
  • Phone: 678-668-5273
  • Fax: 276-208-0023
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTOMIUS WISE
Title or Position: FOUNDER
Credential:
Phone: 678-668-5273