Provider Demographics
NPI:1386486967
Name:WELL CARE HOME HEALTH OF BRUNSWICKCO, INC.
Entity type:Organization
Organization Name:WELL CARE HOME HEALTH OF BRUNSWICKCO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LONG
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:
Practice Address - Street 1:118 OCEAN HIGHWAY WEST
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-0475
Practice Address - Country:US
Practice Address - Phone:910-362-9405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health