- Enrollment id
- O20220603000045
- Enrollment state
- MI
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255095436
- Multiple npi flag
- N
- Ccn
- 239349
- Associate id
- 1153709142
- Organization name
- WISDOM HOME HEALTH CARE INC
- Incorporation date
- 2021-08-21
- Incorporation state
- MI
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 26645 W 12 MILE RD
- Address line 2
- STE 211
- City
- SOUTHFIELD
- State
- MI
- Zip code
- 480347812