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General NPI Number Information
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NPI Number | 1952929408
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Entity Type | Organization
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Legal Business Name | COMPLETE WELL-CARE SOURCE LLC
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 1320 LANDSDOWN DR
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City | SALISBURY
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State | NC
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Zip | 28147-7373
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Country | US
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Telephone | 980-330-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 LANDSDOWN DR
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City | SALISBURY
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State | NC
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Zip | 28147-7373
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Country | US
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Telephone | 980-330-3432
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MYRA VAUGHTERS WILSON
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Credential |
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Telephone | 336-682-8968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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