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General NPI Number Information
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NPI Number | 1134751035
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Entity Type | Organization
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Legal Business Name | WELLCARE HEALTH LLC
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 315 DRY MILL RD SW
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City | LEESBURG
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State | VA
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Zip | 20175-2601
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Country | US
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Telephone | 586-215-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 125 ROY CT SE
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City | LEESBURG
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State | VA
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Zip | 20175-6170
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Country | US
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Telephone | 586-215-8990
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOBBY KOREZ ZACHARIAH
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Credential | PT
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Telephone | 586-215-8990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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