Provider Demographics
NPI:1568199008
Name:WELL CARE COMMUNITY HEALTH, INC.
Entity Type:Organization
Organization Name:WELL CARE COMMUNITY HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-964-4100
Mailing Address - Street 1:100 MATTIE HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47330-1335
Mailing Address - Country:US
Mailing Address - Phone:765-855-3435
Mailing Address - Fax:
Practice Address - Street 1:100 MATTIE HARRIS RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IN
Practice Address - Zip Code:47330-1335
Practice Address - Country:US
Practice Address - Phone:765-855-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELL CARE COMMUNITY HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-04
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty