MEDICARE: WELLCARE HOME CARE AGENCY 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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1841897030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLCARE HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	142 LANCASTER EST
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-1710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 LANCASTER EST
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-1710
Country	:	US
Telephone Number	:	717-723-0378
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIJESH PATEL
Credential	:
Telephone Number	:	717-723-0378

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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