Healthcare Provider Details

I. General information

NPI: 1114014412
Provider Name (Legal Business Name): WELLCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S TELSHOR BLVD SUITE C201
LAS CRUCES NM
88011-8212
US

IV. Provider business mailing address

6688 N CENTRAL EXPY SUITE 1300
DALLAS TX
75206-3950
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-8302
  • Fax: 575-524-8263
Mailing address:
  • Phone: 214-239-6500
  • Fax: 214-239-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3250
License Number StateNM

VIII. Authorized Official

Name: JULIE DIANE JOLLEY
Title or Position: EVP OF HOME HEALTH OPERATIONS
Credential:
Phone: 214-239-6500