Provider Demographics
NPI:1083246458
Name:WP WILDCAT, INC.
Entity Type:Organization
Organization Name:WP WILDCAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:BURCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MBA
Authorized Official - Phone:440-666-1864
Mailing Address - Street 1:278 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2461
Mailing Address - Country:US
Mailing Address - Phone:440-243-5057
Mailing Address - Fax:440-201-6333
Practice Address - Street 1:278 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2461
Practice Address - Country:US
Practice Address - Phone:440-243-5057
Practice Address - Fax:440-201-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care