Provider Demographics
NPI:1164749560
Name:WILLCARE
Entity Type:Organization
Organization Name:WILLCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-348-7808
Mailing Address - Street 1:3695 MILESTRIP RD
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-1526
Mailing Address - Country:US
Mailing Address - Phone:716-348-7808
Mailing Address - Fax:
Practice Address - Street 1:3695 MILESTRIP RD
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-1526
Practice Address - Country:US
Practice Address - Phone:716-348-7808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280199251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health