Provider Demographics
NPI:1902382583
Name:WELL CARE HOME HEALTH OF THE UPSTATE, INC
Entity Type:Organization
Organization Name:WELL CARE HOME HEALTH OF THE UPSTATE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDIESUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-338-5416
Mailing Address - Street 1:6752 PARKER FARM DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3175
Mailing Address - Country:US
Mailing Address - Phone:910-338-5416
Mailing Address - Fax:910-362-9948
Practice Address - Street 1:6752 PARKER FARM DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3175
Practice Address - Country:US
Practice Address - Phone:910-338-5416
Practice Address - Fax:910-362-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health