Provider Demographics
NPI:1568807857
Name:WAVECARE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:WAVECARE HEALTH SERVICES, LLC
Other - Org Name:WAVECARE HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WAVENEY
Authorized Official - Middle Name:ALBERTHA
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-237-1141
Mailing Address - Street 1:1353 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4823
Mailing Address - Country:US
Mailing Address - Phone:813-699-3405
Mailing Address - Fax:813-699-3406
Practice Address - Street 1:1353 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4823
Practice Address - Country:US
Practice Address - Phone:301-237-1141
Practice Address - Fax:202-388-9558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUB PART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1144498817Medicare NSC