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General NPI Number Information
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NPI Number | 1003751850
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Entity Type | Organization
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Legal Business Name | WISDOM COMMUNITY HEALTH LLC
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 600 PINE ST
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City | LOWELL
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State | MA
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Zip | 01851-2309
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Country | US
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Telephone | 978-338-7360
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Fax | 978-797-9682
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Provider Business Mailing Address
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Address Line | 265 CHELMSFORD ST STE 7
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City | CHELMSFORD
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State | MA
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Zip | 01824-2335
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Country | US
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Telephone | 978-338-7360
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Fax | 978-797-9682
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Authorized Official
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Title or Position | OWNER
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Name | DECLAN FOTOH
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Credential |
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Telephone | 978-338-7360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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