MEDICARE: WAKE FOREST BAPTIST HEALTH CARE AT HOME, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861422990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE FOREST BAPTIST HEALTH CARE AT HOME, LLC

Provider Business Mailing Address
First Line	:	6330 SPRINT PKWY STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 FRONTIS PLAZA BLVD
Second Line	:	SUITE 303
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5616
Country	:	US
Telephone Number	:	336-760-1838
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	913-814-2077

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/10/2023

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