Provider Demographics
NPI:1073591376
Name:WELLSTAR HOME HEALTH, LLC
Entity Type:Organization
Organization Name:WELLSTAR HOME HEALTH, LLC
Other - Org Name:WELLSTAR HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-792-7600
Mailing Address - Street 1:1800 PARKWAY PL SE STE 720
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8295
Mailing Address - Country:US
Mailing Address - Phone:470-267-4900
Mailing Address - Fax:770-792-1650
Practice Address - Street 1:1800 PARKWAY PL SE STE 720
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8295
Practice Address - Country:US
Practice Address - Phone:470-267-4900
Practice Address - Fax:770-792-1650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLSTAR HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-06
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003-141251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00482886AMedicaid
580968382-003OtherBC/BS
580968382-008OtherTRICARE
2360094OtherAETNA
580968382-003OtherBC/BS