Healthcare Provider Details

I. General information

NPI: 1982927455
Provider Name (Legal Business Name): WILLCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 COLE RD
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

6330 COLE RD
ORCHARD PARK NY
14127
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-7911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1310751
License Number StateNY

VIII. Authorized Official

Name: MARY COVERLEY
Title or Position: LPN
Credential:
Phone: 716-662-7911