Provider Demographics
NPI:1457121832
Name:WALI HOME CARE LLC
Entity Type:Organization
Organization Name:WALI HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KALELOT
Authorized Official - Middle Name:
Authorized Official - Last Name:LA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-715-0081
Mailing Address - Street 1:5810 WAYCROSS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46816-3845
Mailing Address - Country:US
Mailing Address - Phone:260-715-0081
Mailing Address - Fax:260-296-2677
Practice Address - Street 1:5810 WAYCROSS DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-3845
Practice Address - Country:US
Practice Address - Phone:260-715-0081
Practice Address - Fax:260-296-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care