1922289586 NPI number — WELL CARE CENTERS LLC

Table of content: (NPI 1922289586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922289586 NPI number — WELL CARE CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELL CARE CENTERS 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:
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:
1922289586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 NORTH MONONGAHELA AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-673-2710
Provider Business Mailing Address Fax Number:
412-673-9311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4941 CLAIRTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15236-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-673-2710
Provider Business Practice Location Address Fax Number:
412-673-9311
Provider Enumeration Date:
11/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DONOFRIO
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-673-2710

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  029404 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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