Provider Demographics
NPI:1154980043
Name:WELLPOINT NURSING SERVICES,INC.
Entity type:Organization
Organization Name:WELLPOINT NURSING SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:OKENKPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-985-6492
Mailing Address - Street 1:4126 WINDMILL CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4441
Mailing Address - Country:US
Mailing Address - Phone:443-985-6492
Mailing Address - Fax:443-548-2778
Practice Address - Street 1:4126 WINDMILL CIR STE 1
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4441
Practice Address - Country:US
Practice Address - Phone:443-985-6492
Practice Address - Fax:443-548-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health