Provider Demographics
NPI:1053974550
Name:WISH YOU WELL YOUTH FAITH FOUNDATION INC
Entity type:Organization
Organization Name:WISH YOU WELL YOUTH FAITH FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARMON
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-834-5377
Mailing Address - Street 1:950 EAGLES LANDING PKWY # 756
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7343
Mailing Address - Country:US
Mailing Address - Phone:678-834-5377
Mailing Address - Fax:
Practice Address - Street 1:147 LAUGHLIN DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248
Practice Address - Country:US
Practice Address - Phone:678-834-5377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
364SP0812XOtherYOUTH HANDS ON TRAINING CONTRACTOR
171W00000XOtherYOUTH ORGANIZATION PROGRAMS/HANDS ON TRAINING PROGRAMS
251300000XOtherEDUCATION YOUTH ORGANIZATION CONTRACTOR HANDS ON TRAINING PROGRAMS