1619454162 NPI number — WELLCARE HOSPICE LLC

Table of content: DANIELLE EILEEN CORA PMHNP (NPI 1508562133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619454162 NPI number — WELLCARE HOSPICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLCARE HOSPICE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619454162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6760 OLD JACKSONVILLE HWY STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75703-0567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 TIMBERLOCH PL STE 185
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-1192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-462-4488
Provider Business Practice Location Address Fax Number:
713-324-8953
Provider Enumeration Date:
07/26/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANIER
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
PARTNER, CHIEF GROWTH OFFICER
Authorized Official Telephone Number:
903-932-1852

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)