Provider Demographics
NPI:1114014412
Name:WELLCARE, INC.
Entity Type:Organization
Organization Name:WELLCARE, INC.
Other - Org Name:ENHABIT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRISSY
Authorized Official - Middle Name:BUCHANAN
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-239-6500
Mailing Address - Street 1:6688 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3950
Mailing Address - Country:US
Mailing Address - Phone:214-239-6500
Mailing Address - Fax:214-239-6581
Practice Address - Street 1:425 S TELSHOR BLVD
Practice Address - Street 2:SUITE C201
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8212
Practice Address - Country:US
Practice Address - Phone:575-524-8302
Practice Address - Fax:575-524-8263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENHABIT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3250251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3250OtherSTATE LICENSE
NM000N2876Medicaid
NM32D0916778OtherCLIA
NM000N2876Medicaid