1821394305 NPI number — WELL CARE HOME HEALTH OF THE TRIANGLE, INC

Table of content: (NPI 1821394305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821394305 NPI number — WELL CARE HOME HEALTH OF THE TRIANGLE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELL CARE HOME HEALTH OF THE TRIANGLE, INC
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:
1821394305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 RACINE DR STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-8752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-362-9405
Provider Business Mailing Address Fax Number:
910-202-1376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 GLENWOOD AVE STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27612-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-846-1018
Provider Business Practice Location Address Fax Number:
919-846-5954
Provider Enumeration Date:
02/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
910-362-9405

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC0074 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: HC0074 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 009E1 . This is a "PRIVATE DUTY NURSING-BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3417192 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100623 . This is a "PRIVATE DUTY - MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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