Healthcare Provider Details

I. General information

NPI: 1336516350
Provider Name (Legal Business Name): WELLCARE HEALTH MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BROADHOLLOW RD SUITE 25
MELVILLE NY
11747-3669
US

IV. Provider business mailing address

445 BROADHOLLOW RD SUITE 25
MELVILLE NY
11747-3669
US

V. Phone/Fax

Practice location:
  • Phone: 631-881-0821
  • Fax: 866-863-5865
Mailing address:
  • Phone: 631-881-0821
  • Fax: 866-863-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HANG GUO
Title or Position: CEO
Credential:
Phone: 631-881-0821