Provider Demographics
NPI:1558058057
Name:WENTWORTH HEALTHCARE LLC
Entity type:Organization
Organization Name:WENTWORTH HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:256-469-0015
Mailing Address - Street 1:4800 WHITESBURG DR
Mailing Address - Street 2:ST 30. #186
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:509-495-1142
Practice Address - Street 1:2136 NOEL DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2086
Practice Address - Country:US
Practice Address - Phone:256-469-0015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty