1073591376 NPI number — WELLSTAR HOME HEALTH, LLC

Table of content: (NPI 1073591376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073591376 NPI number — WELLSTAR HOME HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSTAR HOME HEALTH, 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:
WELLSTAR HOME HEALTH
Provider Other Organization Name Type Code:
3
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:
1073591376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 PARKWAY PL SE STE 720
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067-8295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-267-4900
Provider Business Mailing Address Fax Number:
770-792-1650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 PARKWAY PL SE STE 720
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067-8295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-267-4900
Provider Business Practice Location Address Fax Number:
770-792-1650
Provider Enumeration Date:
01/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUDZINSKI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE VP & CFO
Authorized Official Telephone Number:
770-792-7600

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  003-141 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00482886A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 580968382-003 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 580968382-008 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2360094 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".