Healthcare Provider Details

I. General information

NPI: 1881032837
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: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SNEAD ST
WELDON NC
27890-1747
US

IV. Provider business mailing address

2704 N CHURCH ST
GREENSBORO NC
27405-3657
US

V. Phone/Fax

Practice location:
  • Phone: 252-678-3731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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