Provider Demographics
NPI:1760780126
Name:WELCORE HEALTH, LLC
Entity Type:Organization
Organization Name:WELCORE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOEBY
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, CPHC, MT, SC
Authorized Official - Phone:701-746-5359
Mailing Address - Street 1:718 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4460
Mailing Address - Country:US
Mailing Address - Phone:701-746-5359
Mailing Address - Fax:701-746-5359
Practice Address - Street 1:718 OAK ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4460
Practice Address - Country:US
Practice Address - Phone:701-746-5359
Practice Address - Fax:701-746-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN716915OtherMEDICARE PTAN