Provider Demographics
NPI:1073985099
Name:WOLVERINE CORPORATION
Entity Type:Organization
Organization Name:WOLVERINE CORPORATION
Other - Org Name:CHARLES HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SHANG
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-419-9610
Mailing Address - Street 1:20 TOWER LN STE 500
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4263
Mailing Address - Country:US
Mailing Address - Phone:914-419-9610
Mailing Address - Fax:845-226-1305
Practice Address - Street 1:20 TOWER LN STE 500
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4263
Practice Address - Country:US
Practice Address - Phone:914-419-9610
Practice Address - Fax:845-226-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0000795251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health