Provider Demographics
NPI:1568973741
Name:ALEXA WELLCARE LLC
Entity Type:Organization
Organization Name:ALEXA WELLCARE LLC
Other - Org Name:ALEXA WELLCARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-990-7249
Mailing Address - Street 1:2029 CENTURY PARK E STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2905
Mailing Address - Country:US
Mailing Address - Phone:310-990-7249
Mailing Address - Fax:
Practice Address - Street 1:2029 CENTURY PARK E STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2905
Practice Address - Country:US
Practice Address - Phone:310-990-7249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8222844269253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8222844269Medicaid