Provider Demographics
NPI:1538854534
Name:WISE HOME CARE LLC
Entity type:Organization
Organization Name:WISE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:MBARATO
Authorized Official - Last Name:RUNEZERWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-400-8579
Mailing Address - Street 1:207 N PARK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-2002
Mailing Address - Country:US
Mailing Address - Phone:319-400-8579
Mailing Address - Fax:
Practice Address - Street 1:207 N PARK RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-2002
Practice Address - Country:US
Practice Address - Phone:319-400-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health