Provider Demographics
NPI:1467889196
Name:WELLPOINT HOME HEALTH,INC
Entity Type:Organization
Organization Name:WELLPOINT HOME HEALTH,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA
Authorized Official - Phone:773-732-8790
Mailing Address - Street 1:9245 CALUMET AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2821
Mailing Address - Country:US
Mailing Address - Phone:773-732-8790
Mailing Address - Fax:773-253-9961
Practice Address - Street 1:9245 CALUMET AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2821
Practice Address - Country:US
Practice Address - Phone:773-732-8790
Practice Address - Fax:773-253-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health