MEDICARE: WILLDORC GENERAL ENTERPRISE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1013865187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLDORC GENERAL ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	14814 CYPRESS GREEN DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-1982
Country	:	US
Telephone Number	:	346-391-0976
Fax Number	:

Provider Business Practice Location Address
First Line	:	14814 CYPRESS GREEN DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-1982
Country	:	US
Telephone Number	:	346-391-0976
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ADMINISTRATOR
Name	:	EKE DAVID
Credential	:
Telephone Number	:	346-391-0976

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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