Provider Demographics
NPI:1649396508
Name:DEFELICECARE, INC.
Entity Type:Organization
Organization Name:DEFELICECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEFELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-232-4210
Mailing Address - Street 1:76 SIXTEENTH ST
Mailing Address - Street 2:200
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0618
Mailing Address - Country:US
Mailing Address - Phone:304-232-4210
Mailing Address - Fax:304-232-4213
Practice Address - Street 1:138 ROCKDALE RD
Practice Address - Street 2:SUITE B
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1658
Practice Address - Country:US
Practice Address - Phone:304-723-0280
Practice Address - Fax:304-723-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV054968332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1007375850010Medicaid
WV001705530OtherBCBS
WV0147477000Medicaid
WV0147477000Medicaid