Provider Demographics
NPI:1144498817
Name:WAVECARE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:WAVECARE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WAVENEY
Authorized Official - Middle Name:ALBERTHA
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-237-1141
Mailing Address - Street 1:1405 H ST NE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5008
Mailing Address - Country:US
Mailing Address - Phone:301-237-1141
Mailing Address - Fax:202-388-9558
Practice Address - Street 1:1405 H ST NE
Practice Address - Street 2:SUITE # 2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5008
Practice Address - Country:US
Practice Address - Phone:301-237-1141
Practice Address - Fax:202-388-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6134050002Medicare NSC