Provider Demographics
NPI:1750943304
Name:WELLSTAR HOME HEALTH SERVICES, INC
Entity type:Organization
Organization Name:WELLSTAR HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-316-5603
Mailing Address - Street 1:479 MASON ST STE 309
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4542
Mailing Address - Country:US
Mailing Address - Phone:707-689-5674
Mailing Address - Fax:707-689-5274
Practice Address - Street 1:479 MASON ST STE 309
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4542
Practice Address - Country:US
Practice Address - Phone:707-689-5674
Practice Address - Fax:707-689-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health