Provider Demographics
NPI:1144212408
Name:DEFELICECARE INC
Entity Type:Organization
Organization Name:DEFELICECARE INC
Other - Org Name:DEFELICECARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-232-4210
Mailing Address - Street 1:76 SIXTEENTH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3660
Mailing Address - Country:US
Mailing Address - Phone:304-232-4210
Mailing Address - Fax:304-232-4213
Practice Address - Street 1:76 SIXTEENTH ST
Practice Address - Street 2:STE 200
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3660
Practice Address - Country:US
Practice Address - Phone:304-232-4210
Practice Address - Fax:304-232-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP0552381332B00000X
333600000X, 3336C0003X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2171395Medicaid
5055668OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WV0147477001Medicaid
OH2171395Medicaid