Provider Demographics
NPI:1124536446
Name:WELL CARE HOME HEALTH OF THE LOWCOUNTRY
Entity type:Organization
Organization Name:WELL CARE HOME HEALTH OF THE LOWCOUNTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-362-9405
Mailing Address - Street 1:131 RACINE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8752
Mailing Address - Country:US
Mailing Address - Phone:910-362-9405
Mailing Address - Fax:910-202-1376
Practice Address - Street 1:1200 48TH AVE N UNIT 101
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5446
Practice Address - Country:US
Practice Address - Phone:843-712-7095
Practice Address - Fax:910-202-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health