Provider Demographics
NPI:1639674765
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:MICHAEL
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:336-272-8335
Mailing Address - Street 1:10 OAK BRANCH DR STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2995
Mailing Address - Country:US
Mailing Address - Phone:336-272-8335
Mailing Address - Fax:336-272-8339
Practice Address - Street 1:1080 WALDEN RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-1544
Practice Address - Country:US
Practice Address - Phone:336-736-8627
Practice Address - Fax:336-272-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-076-129320600000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418297Medicaid