Provider Demographics
NPI:1821394305
Name:WELL CARE HOME HEALTH OF THE TRIANGLE, INC
Entity Type:Organization
Organization Name:WELL CARE HOME HEALTH OF THE TRIANGLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:COLEY
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 210
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 1:8341 BANDFORD WAY
Practice Address - Street 2:SUITE 001
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2098
Practice Address - Country:US
Practice Address - Phone:919-846-1018
Practice Address - Fax:919-846-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0074251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC009E1OtherPRIVATE DUTY NURSING-BCBS
NC3417192Medicaid
NC7100623OtherPRIVATE DUTY - MEDICAID