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General NPI Number Information
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NPI Number | 1336587344
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Entity Type | Organization
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Legal Business Name | WESCARE PROFESSIONAL SERVICES, LLC.
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 816 CLARKWAY AVE
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City | EDEN
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State | NC
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Zip | 27288-2416
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Country | US
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Telephone | 336-623-0679
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Fax |
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Provider Business Mailing Address
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Address Line | 2704 N CHURCH ST
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City | GREENSBORO
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State | NC
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Zip | 27405-3657
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. ERIC M. PAGE
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Credential | QP
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Telephone | 336-272-8335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | MHL-079-074
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-079-074
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License Number State | NC
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