Provider Demographics
NPI:1912016932
Name:WELLNESS HOME CARE, LTD.
Entity Type:Organization
Organization Name:WELLNESS HOME CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:CHARLOTTE
Authorized Official - Last Name:BALABAN-KRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:845-294-8364
Mailing Address - Street 1:252 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2178
Mailing Address - Country:US
Mailing Address - Phone:845-294-8364
Mailing Address - Fax:845-294-8966
Practice Address - Street 1:252 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2178
Practice Address - Country:US
Practice Address - Phone:845-294-8364
Practice Address - Fax:845-294-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0023L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00925282Medicaid
NY01009205Medicaid