Provider Demographics
NPI:1811978877
Name:WELCOV HEALTHCARE LLC
Entity type:Organization
Organization Name:WELCOV HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSIGNEE
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:DYBSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-323-2266
Mailing Address - Street 1:420 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1718
Mailing Address - Country:US
Mailing Address - Phone:651-224-2368
Mailing Address - Fax:651-224-3582
Practice Address - Street 1:420 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1718
Practice Address - Country:US
Practice Address - Phone:651-224-2368
Practice Address - Fax:651-224-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330053314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN493226900Medicaid