Provider Demographics
NPI:1326016577
Name:WELLER HOMECARE PRODUCTS
Entity Type:Organization
Organization Name:WELLER HOMECARE PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-883-3118
Mailing Address - Street 1:410 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025
Mailing Address - Country:US
Mailing Address - Phone:518-883-3118
Mailing Address - Fax:518-883-4357
Practice Address - Street 1:410 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025
Practice Address - Country:US
Practice Address - Phone:518-883-3118
Practice Address - Fax:518-883-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
7628357OtherAETNA
10063652OtherCDPHP
NY02166865Medicaid
NY02166865Medicaid