Provider Demographics
NPI:1508115361
Name:WELCORE HEALTH,LLC
Entity Type:Organization
Organization Name:WELCORE HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-772-8782
Mailing Address - Street 1:1720 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-8107
Mailing Address - Country:US
Mailing Address - Phone:701-772-8782
Mailing Address - Fax:
Practice Address - Street 1:1720 WILLOW DR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-8107
Practice Address - Country:US
Practice Address - Phone:701-772-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR11385261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center