Provider Demographics
NPI:1538521141
Name:WESERVE HEALTHCARE INC
Entity type:Organization
Organization Name:WESERVE HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OFODILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-322-8090
Mailing Address - Street 1:4432 STONEWALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604
Mailing Address - Country:US
Mailing Address - Phone:732-322-8090
Mailing Address - Fax:919-803-8502
Practice Address - Street 1:5848 FARINGDON PL
Practice Address - Street 2:STE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4591
Practice Address - Country:US
Practice Address - Phone:732-322-8090
Practice Address - Fax:919-803-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4056253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care