Provider Demographics
NPI:1497010771
Name:WELLLIFE HOUSE CALLS
Entity Type:Organization
Organization Name:WELLLIFE HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:919-829-1315
Mailing Address - Street 1:211 E SIX FORKS RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 E SIX FORKS RD
Practice Address - Street 2:SUITE 122
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7745
Practice Address - Country:US
Practice Address - Phone:919-829-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC136549261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care