Provider Demographics
NPI:1063838175
Name:MAJESTIC WELLCARE INC.
Entity Type:Organization
Organization Name:MAJESTIC WELLCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EBUENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-712-1396
Mailing Address - Street 1:500 S KRAEMER BLVD
Mailing Address - Street 2:SUITE 165
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6728
Mailing Address - Country:US
Mailing Address - Phone:714-996-3500
Mailing Address - Fax:714-996-3552
Practice Address - Street 1:500 S KRAEMER BLVD
Practice Address - Street 2:SUITE 165
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6728
Practice Address - Country:US
Practice Address - Phone:714-996-3500
Practice Address - Fax:714-996-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based