MEDICARE: WISEMINDS HEALTHCARE NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	252Y00000X	Early Intervention Provider Agency
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1093266934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISEMINDS HEALTHCARE NETWORK

Provider Business Mailing Address
First Line	:	7636 WYNDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2707
Country	:	US
Telephone Number	:	267-836-3872
Fax Number	:

Provider Business Practice Location Address
First Line	:	7636 WYNDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2707
Country	:	US
Telephone Number	:	267-836-3872
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KIANNA L FOSTER
Credential	:
Telephone Number	:	215-279-1509

Provider Enumeration Date	:	10/15/2016
Last Update Date	:	10/15/2016

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