Healthcare Provider Details

I. General information

NPI: 1447962105
Provider Name (Legal Business Name): WELL CARE COMMUNITY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S FERGUSON ST
HENRYVILLE IN
47126-9734
US

IV. Provider business mailing address

203 E MAIN ST
RICHMOND IN
47374-4208
US

V. Phone/Fax

Practice location:
  • Phone: 812-794-8100
  • Fax: 812-794-8200
Mailing address:
  • Phone: 765-973-9294
  • Fax: 765-973-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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