Organization
FAMILY WISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULETTE ISAAC (OWNER/MEMBER)
(215) 352-4661
Entity
Organization
Contact information
Practice address
7516 CITY AVE STE A, PHILADELPHIA, PA 19151-2102
(215) 352-4661
(267) 519-3186
Mailing address
3422 W COMMISSIONER ST, PHILADELPHIA, PA 19132-1828
(302) 365-6329
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029391690001
—
PA
05
—
102939169001
—
PA
Enumeration date
09/28/2018
Last updated
09/28/2018
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