=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154646743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2010
-----------------------------------------------------
Last Update Date | 04/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 HILLWOOD DR
-----------------------------------------------------
City | CHEEKTOWAGA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14227-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-668-2611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 HILLWOOD DR
-----------------------------------------------------
City | CHEEKTOWAGA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14227-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-668-2611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPN
-----------------------------------------------------
Name | CATHERINE FISHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-668-2611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 616761
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------