Basic Information
| Provider Information | |||||||||
| NPI: | 1407326994 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELL CARE FOUNDATION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3312 W CHARLESTON BLVD | ||||||||
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| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024107825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 315 RECORD ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895123327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753488811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2018 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | MALINIS | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7024107825 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.