Healthcare Provider Details

I. General information

NPI: 1740580596
Provider Name (Legal Business Name): WELLCARE OPTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W PICACHO AVE
LAS CRUCES NM
88005-2337
US

IV. Provider business mailing address

1740 W PICACHO AVE
LAS CRUCES NM
88005-2337
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-9083
  • Fax: 575-647-1471
Mailing address:
  • Phone: 575-525-9083
  • Fax: 575-647-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1T3349
License Number StateNM

VIII. Authorized Official

Name: MR. JONATHAN DAVID BOLDT
Title or Position: DIRECTOR
Credential:
Phone: 575-639-1649