=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104488667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELL CARE NURSING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2019
-----------------------------------------------------
Last Update Date | 07/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12001 CARRINGTON LN APT 205
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45140-6294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-444-9370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12001 CARRINGTON LN APT 205
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45140-6294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-444-9370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN
-----------------------------------------------------
Name | ILIAS BAIDJIEV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-444-9370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------