Provider Demographics
NPI:1427039734
Name:WELLMONT HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:WELLMONT HEALTH SYSTEM INC
Other - Org Name:COMMONWEALTH HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAWCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-230-8475
Mailing Address - Street 1:2971 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4005
Mailing Address - Country:US
Mailing Address - Phone:423-230-8443
Mailing Address - Fax:423-845-7874
Practice Address - Street 1:988 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2428
Practice Address - Country:US
Practice Address - Phone:276-676-3138
Practice Address - Fax:276-676-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4971035Medicaid
VA4971035Medicaid