=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639367998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 N PENNSYLVANIA AVE STE 1250
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88201-4791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-622-9355
-----------------------------------------------------
Fax | 507-633-9370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6688 N CENTRAL EXPY SUITE 1300
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-3950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-239-6500
-----------------------------------------------------
Fax | 214-239-6581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP OF HOME HEALTH OPERATIONS
-----------------------------------------------------
Name | JULIE DIANE JOLLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-239-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 3249
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------