Healthcare Provider Details

I. General information

NPI: 1952342784
Provider Name (Legal Business Name): WELL CARE HOME HEALTH OF THE TRIAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 DORNACH WAY STE 210
ADVANCE NC
27006-7305
US

IV. Provider business mailing address

131 RACINE DR STE 201
WILMINGTON NC
28403-8752
US

V. Phone/Fax

Practice location:
  • Phone: 336-753-6200
  • Fax: 336-751-9287
Mailing address:
  • Phone: 910-362-9405
  • Fax: 910-202-1376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA MOORE
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 910-362-9405