Provider Demographics
NPI:1932590700
Name:WELLCARE RESIDENCE
Entity Type:Organization
Organization Name:WELLCARE RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIEUX-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-864-4795
Mailing Address - Street 1:9 NORTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:609-261-1794
Practice Address - Street 1:9 NORTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1324
Practice Address - Country:US
Practice Address - Phone:609-864-4795
Practice Address - Fax:609-261-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home