NPIMap

Organization Active NPI

Wish You Well Youth Faith Foundation Inc

  • Contractor
  • Locust Grove, GA
National Provider Identifier
1053974550
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ContractorTaxonomy code 171W00000X
Legal business name
WISH YOU WELL YOUTH FAITH FOUNDATION INC
Practice address
147 Laughlin Dr
Locust Grove, GA 30248
Phone
(678) 834-5377
NPI assigned
Apr 19, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sharmon D Causey
Title
Ceo/Director
Phone
(678) 834-5377

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ContractorGroup: 193400000X SINGLE SPECIALTY GROUP 171W00000X Primary

Addresses

Primary practice location

147 Laughlin Dr
Locust Grove, GA 30248

Mailing address

950 Eagles Landing Pkwy # 756
Stockbridge, GA 30281-7343
Phone (678) 834-5377

Other identifiers 3

IdentifierTypeStateIssuer
364SP0812XOtherYOUTH HANDS ON TRAINING CONTRACTOR
171W00000XOtherYOUTH ORGANIZATION PROGRAMS/HANDS ON TRAINING PROGRAMS
251300000XOtherEDUCATION YOUTH ORGANIZATION CONTRACTOR HANDS ON TRAINING PROGRAMS

Other names 1

  • Wish You Well Youth Faith Foundation Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wish You Well Youth Faith Foundation Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1053974550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 EAGLES LANDING PKWY # 756",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817343",
            "telephone_number": "678-834-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 LAUGHLIN DR",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "30248",
            "telephone_number": "678-834-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISH YOU WELL YOUTH FAITH FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-19",
        "last_updated": "2022-08-12",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "CAUSEY",
        "authorized_official_first_name": "SHARMON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO/DIRECTOR",
        "authorized_official_telephone_number": "678-834-5377"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "YOUTH HANDS ON TRAINING CONTRACTOR",
            "identifier": "364SP0812X",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "YOUTH ORGANIZATION PROGRAMS/HANDS ON TRAINING PROGRAMS",
            "identifier": "171W00000X",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATION YOUTH ORGANIZATION CONTRACTOR HANDS ON TRAINING PROGRAMS",
            "identifier": "251300000X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wish You Well Youth Faith Foundation Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Locust Grove, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.