Provider Demographics
NPI:1538228663
Name:WELLCARE HOME HEALTH INC
Entity type:Organization
Organization Name:WELLCARE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-254-4453
Mailing Address - Street 1:1020 WOODMAN DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432
Mailing Address - Country:US
Mailing Address - Phone:937-254-4453
Mailing Address - Fax:937-254-4855
Practice Address - Street 1:1020 WOODMAN DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432
Practice Address - Country:US
Practice Address - Phone:937-254-4453
Practice Address - Fax:937-254-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2000122Medicaid
OH367786Medicare Oscar/Certification