MEDICARE: WISH CHARTER SCHOOL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1326998618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISH CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	6550 W 80TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1127
Country	:	US
Telephone Number	:	310-410-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 W 80TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1127
Country	:	US
Telephone Number	:	310-410-9940
Fax Number	:

Authorized Official
Title or Position	:	FINANCE MANAGER
Name	:	JENNIE BROOK
Credential	:
Telephone Number	:	310-743-6990

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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Directions to “WISH CHARTER SCHOOL ” Practice Location

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