Provider Demographics
NPI:1760470660
Name:WELL CARE HOME HEALTH, INC
Entity Type:Organization
Organization Name:WELL CARE HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-362-9405
Mailing Address - Street 1:6752 PARKER FARM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3175
Mailing Address - Country:US
Mailing Address - Phone:910-362-9405
Mailing Address - Fax:910-790-3169
Practice Address - Street 1:6752 PARKER FARM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3175
Practice Address - Country:US
Practice Address - Phone:910-362-9405
Practice Address - Fax:910-790-3169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELL CARE DME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-13
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1231251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0073NOtherBLUE CROSS BLUE SHIELD
NC3427002Medicaid
NC0073NOtherBLUE CROSS BLUE SHIELD
NC347002Medicare PIN