Basic Information
| Provider Information | |||||||||
| NPI: | 1699714006 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WELL-CARE HOME HEALTH INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MERIDA HEALTH CARE GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1230 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785511230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564231197 | ||||||||
| FaxNumber: | 9564401837 | ||||||||
| Practice Location | |||||||||
| Address1: | 10103 FONDREN RD | ||||||||
| Address2: | SUITE: 230 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770964556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819885304 | ||||||||
| FaxNumber: | 2819885309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MESQUIAS | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9564231197 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251F00000X | 010303 | TX | N | Agencies | Home Infusion | 251J00000X | 010303 | TX | N | Agencies | Nursing Care | 251G00000X | 010303 | TX | N | Agencies | Hospice Care, Community Based | 251E00000X | 010303 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 200139801 | 05 | TX | MEDICAID |