Provider Demographics
NPI:1588012744
Name:WGR HOLDINGS MELBOURNE, LLC
Entity Type:Organization
Organization Name:WGR HOLDINGS MELBOURNE, LLC
Other - Org Name:FIVE STAR HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-241-4433
Mailing Address - Street 1:1900 NW CORPORATE BLVD
Mailing Address - Street 2:STE 100W
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8502
Mailing Address - Country:US
Mailing Address - Phone:321-241-4433
Mailing Address - Fax:321-241-4437
Practice Address - Street 1:760 NORTH DR
Practice Address - Street 2:STE C
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-9216
Practice Address - Country:US
Practice Address - Phone:321-241-4433
Practice Address - Fax:321-241-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-28
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health