Provider Demographics
NPI:1164420451
Name:WELLS HEALTH CARE, INC.
Entity Type:Organization
Organization Name:WELLS HEALTH CARE, INC.
Other - Org Name:COUNTRYSIDE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SKAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-9355
Mailing Address - Street 1:725 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6185
Mailing Address - Country:US
Mailing Address - Phone:270-926-9355
Mailing Address - Fax:270-684-6283
Practice Address - Street 1:47 MARGO AVE
Practice Address - Street 2:
Practice Address - City:BARDWELL
Practice Address - State:KY
Practice Address - Zip Code:42023-9005
Practice Address - Country:US
Practice Address - Phone:270-628-5424
Practice Address - Fax:270-628-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100663314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12502639Medicaid
KY18-5382Medicare ID - Type Unspecified