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General NPI Number Information
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NPI Number | 1073985099
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Entity Type | Organization
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Legal Business Name | WOLVERINE CORPORATION
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 20 TOWER LN STE 500
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City | AVON
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State | CT
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Zip | 06001-4263
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Country | US
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Telephone | 914-419-9610
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Fax | 845-226-1305
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Provider Business Mailing Address
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Address Line | 20 TOWER LN STE 500
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City | AVON
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State | CT
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Zip | 06001-4263
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Country | US
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Telephone | 914-419-9610
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Fax | 845-226-1305
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN SHANG LEW
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Credential |
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Telephone | 914-419-9610
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCA.0000795
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License Number State | CT
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