Healthcare Provider Details

I. General information

NPI: 1518125418
Provider Name (Legal Business Name): WECARE EXTENDED MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 SALEM CHURCH RD
CHARLESTOWN IN
47111-9262
US

IV. Provider business mailing address

8206 SALEM CHURCH RD
CHARLESTOWN IN
47111
US

V. Phone/Fax

Practice location:
  • Phone: 502-819-4318
  • Fax:
Mailing address:
  • Phone: 502-819-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number46008
License Number StateKY

VIII. Authorized Official

Name: MRS. DIAN S WRIGHT
Title or Position: OWNER
Credential: NP
Phone: 502-819-4318