Provider Demographics
NPI:1891131868
Name:WSH CAP SERVICES
Entity Type:Organization
Organization Name:WSH CAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNATHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-479-9856
Mailing Address - Street 1:PO BOX 260714
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-7714
Mailing Address - Country:US
Mailing Address - Phone:910-242-9006
Mailing Address - Fax:
Practice Address - Street 1:603 EASTCHESTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7673
Practice Address - Country:US
Practice Address - Phone:910-242-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE SWAN HOME HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4238251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418949Medicaid