Provider Demographics
NPI:1093104531
Name:WELLNESS WATCHERS HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:WELLNESS WATCHERS HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-890-9815
Mailing Address - Street 1:2028 WOODLAND DR STE E203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6356
Mailing Address - Country:US
Mailing Address - Phone:980-298-6896
Mailing Address - Fax:980-298-6897
Practice Address - Street 1:2028 WOODLAND DR STE E203
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6356
Practice Address - Country:US
Practice Address - Phone:980-298-6896
Practice Address - Fax:980-298-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care