Provider Demographics
NPI:1225733348
Name:WELLCARE HOME AGENCY, CORP.
Entity Type:Organization
Organization Name:WELLCARE HOME AGENCY, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-257-5555
Mailing Address - Street 1:PO BOX 530397
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33153-0397
Mailing Address - Country:US
Mailing Address - Phone:863-257-5555
Mailing Address - Fax:
Practice Address - Street 1:11132 PEACHTREE DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6850
Practice Address - Country:US
Practice Address - Phone:863-257-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care