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General NPI Number Information
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NPI Number | 1801371570
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Entity Type | Organization
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Legal Business Name | FAMILY WISE LLC
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 7516 CITY AVE STE A
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City | PHILADELPHIA
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State | PA
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Zip | 19151-2102
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Country | US
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Telephone | 215-352-4661
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Fax | 267-519-3186
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Provider Business Mailing Address
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Address Line | 3422 W COMMISSIONER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19132-1828
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Country | US
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Telephone | 302-365-6329
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | PAULETTE ISAAC
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Credential |
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Telephone | 215-352-4661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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