Provider Demographics
NPI:1205825759
Name:WELL CARE HOME CARE
Entity Type:Organization
Organization Name:WELL CARE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-452-1555
Mailing Address - Street 1:6752 PARKER FARM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3175
Mailing Address - Country:US
Mailing Address - Phone:910-452-1555
Mailing Address - Fax:910-202-1376
Practice Address - Street 1:6752 PARKER FARM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3175
Practice Address - Country:US
Practice Address - Phone:910-452-1555
Practice Address - Fax:910-202-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1231251E00000X
NCHC0088251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601425Medicaid
NC7100525Medicaid
NC0077TOtherBCBS PDN
NC3408345Medicaid
NC6600144Medicaid
NC6601424Medicaid
NC7100096Medicaid
NC7100103Medicaid
NC7100524Medicaid
NC6601426Medicaid