Provider Demographics
NPI:1710438502
Name:HOMEWOOD FAMILY WELLCARE LLC
Entity Type:Organization
Organization Name:HOMEWOOD FAMILY WELLCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-516-3290
Mailing Address - Street 1:1 INDEPENDENCE PLZ STE 410
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2648
Mailing Address - Country:US
Mailing Address - Phone:205-516-3290
Mailing Address - Fax:
Practice Address - Street 1:1 INDEPENDENCE PLZ STE 410
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2648
Practice Address - Country:US
Practice Address - Phone:205-516-3290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty