Provider Demographics
NPI:1568800514
Name:WESCARE PROFESSIONAL SERVICES, LLC.
Entity Type:Organization
Organization Name:WESCARE PROFESSIONAL SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:336-272-8335
Mailing Address - Street 1:2704 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 WADE RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-8946
Practice Address - Country:US
Practice Address - Phone:252-826-6557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418297Medicaid