Healthcare Provider Details

I. General information

NPI: 1962840900
Provider Name (Legal Business Name): WESCARE PROFESSIONAL SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 GORRELL ST
GREENSBORO NC
27401-3507
US

IV. Provider business mailing address

2704 N CHURCH ST
GREENSBORO NC
27405-3657
US

V. Phone/Fax

Practice location:
  • Phone: 336-275-0057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-041-752
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL0-41-752
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-041-752
License Number StateNC

VIII. Authorized Official

Name: MR. ERIC M. PAGE
Title or Position: OPERATIONS MANAGER
Credential: QP
Phone: 336-272-8335