Provider Demographics
NPI:1689032187
Name:WAVECARE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:WAVECARE HEALTH SERVICES LLC
Other - Org Name:WAVECARE HEALTHCARE SERVICE LLC
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:A
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-237-1141
Mailing Address - Street 1:11900 LISBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3405
Mailing Address - Country:US
Mailing Address - Phone:301-237-1141
Mailing Address - Fax:202-388-9555
Practice Address - Street 1:8725 GREENBELT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2475
Practice Address - Country:US
Practice Address - Phone:202-388-9555
Practice Address - Fax:202-388-9558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAVECARE HEALTHCARE SERVICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-29
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3786332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039537200Medicaid
MD421615600Medicaid
MD421615600Medicaid