Healthcare Provider Details

I. General information

NPI: 1568199008
Provider Name (Legal Business Name): WELL CARE COMMUNITY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MATTIE HARRIS RD
CENTERVILLE IN
47330-1335
US

IV. Provider business mailing address

2200 W MAIN ST
RICHMOND IN
47374-3882
US

V. Phone/Fax

Practice location:
  • Phone: 765-855-3435
  • Fax:
Mailing address:
  • Phone: 765-855-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CATHY SUE JARVIS
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 765-973-9294