Provider Demographics
NPI:1649595893
Name:WILLCARE
Entity type:Organization
Organization Name:WILLCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-941-6152
Mailing Address - Street 1:10793 SHARP ST
Mailing Address - Street 2:
Mailing Address - City:EAST CONCORD
Mailing Address - State:NY
Mailing Address - Zip Code:14055-9712
Mailing Address - Country:US
Mailing Address - Phone:716-941-6152
Mailing Address - Fax:
Practice Address - Street 1:10793 SHARP ST
Practice Address - Street 2:
Practice Address - City:EAST CONCORD
Practice Address - State:NY
Practice Address - Zip Code:14055-9712
Practice Address - Country:US
Practice Address - Phone:716-941-6152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218915251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health