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General NPI Number Information
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NPI Number | 1386486967
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Entity Type | Organization
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Legal Business Name | WELL CARE HOME HEALTH OF BRUNSWICKCO, INC.
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Dates
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Enumeration Date | 06/12/2024
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 118 OCEAN HIGHWAY WEST
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City | SUPPLY
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State | NC
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Zip | 28462-0475
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Country | US
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Telephone | 910-362-9405
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Fax |
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Provider Business Mailing Address
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Address Line | 131 RACINE DR STE 201
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City | WILMINGTON
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State | NC
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Zip | 28403-8752
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Country | US
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Telephone | 910-362-9405
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ZACHARY WAYNE LONG
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Credential |
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Telephone | 910-362-9405
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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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