Provider Demographics
NPI:1952342784
Name:WELL CARE HOME HEALTH OF THE TRIAD
Entity type:Organization
Organization Name:WELL CARE HOME HEALTH OF THE TRIAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-362-9405
Mailing Address - Street 1:131 RACINE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8752
Mailing Address - Country:US
Mailing Address - Phone:910-362-9405
Mailing Address - Fax:910-202-1376
Practice Address - Street 1:146 DORNACH WAY STE 210
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-7305
Practice Address - Country:US
Practice Address - Phone:336-753-6200
Practice Address - Fax:336-751-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407051Medicaid
NC347051Medicare Oscar/Certification
NC3407051Medicaid
NC00723OtherBCBSNC
NC347051Medicare Oscar/Certification
NC0000EOtherBCBSNC HOSPICE
NC0417LOtherBCBSNC HOME INFUSSION