Provider Demographics
NPI:1053412122
Name:WISHING U WELL MEDICAL INC
Entity type:Organization
Organization Name:WISHING U WELL MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-234-0096
Mailing Address - Street 1:2217 PLAZA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4421
Mailing Address - Country:US
Mailing Address - Phone:916-234-0096
Mailing Address - Fax:
Practice Address - Street 1:2217 PLAZA DR STE 102
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4421
Practice Address - Country:US
Practice Address - Phone:916-234-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA766369-26332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02796FMedicaid
CA1172860001Medicare NSC