Provider Demographics
NPI:1144611542
Name:WICOFOL HUMAN SERVICES CORPARATION
Entity Type:Organization
Organization Name:WICOFOL HUMAN SERVICES CORPARATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:508-583-5557
Mailing Address - Street 1:1785 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3525
Mailing Address - Country:US
Mailing Address - Phone:508-685-6449
Mailing Address - Fax:508-807-5126
Practice Address - Street 1:1785 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3525
Practice Address - Country:US
Practice Address - Phone:508-685-6449
Practice Address - Fax:508-807-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001086064302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization