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General NPI Number Information
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NPI Number | 1073867784
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Entity Type | Organization
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Legal Business Name | WELLPOINT HOME HEALTH,INC.
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 10912 S WESTERN AVE SUITE 4 N
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City | CHICAGO
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State | IL
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Zip | 60643-3205
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Country | US
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Telephone | 773-253-9190
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Fax | 773-253-9961
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Provider Business Mailing Address
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Address Line | 10912 S WESTERN AVE SUITE 4 N
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City | CHICAGO
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State | IL
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Zip | 60643-3205
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Country | US
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Telephone | 773-253-9190
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Fax | 773-253-9961
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. TRACY MCKENZIE
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Credential | RN,BSN
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Telephone | 773-732-8790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1011534
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License Number State | IL
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