NPIMap

Organization Active NPI

Well Care Home Health of the Lowcountry

  • Home Health Agency
  • Myrtle Beach, SC
National Provider Identifier
1124536446
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
WELL CARE HOME HEALTH OF THE LOWCOUNTRY
Practice address
1200 48TH Ave N Unit 101
Myrtle Beach, SC 29577-5446
Phone
(843) 712-7095
Fax
(910) 202-1376
NPI assigned
Jan 22, 2018
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Moore
Title
Director of Revenue Cycle
Phone
(910) 362-9405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1200 48TH Ave N Unit 101
Myrtle Beach, SC 29577-5446

Mailing address

131 Racine Dr Ste 201
Wilmington, NC 28403-8752
Phone (910) 362-9405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181220003407 SC Part A Provider - Home Health Agency 4688919574 Practice locations: Myrtle Beach, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124536446. Details of each certification follow.

Home health agency certification: CCN 427138

Legal name
WELL CARE HOME HEALTH OF THE LOWCOUNTRY
Doing business as
WELL CARE HOME HEALTH OF THE LOWCOUNTRY
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 8, 2019
Last certification
Apr 8, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Mar 23, 2017 in SC
Enrollment address
1200 48TH Ave. N.
Suite 201
Myrtle Beach, SC 29577-5446
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Well Care Home Health of the Lowcountry IncCCN 427138 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Apr 8, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2149357Well Care Home Health of the Lowcountry, Inc1200 48TH Avenue, N, Suite 201, Myrtle Beach, SC 29577Certificate of waiverMay 31, 2028

National Provider Directory

National Provider Directory

Locations

6752 Parker Farm Dr
Wilmington, NC 28405
Phone (910) 338-5416

1039 44th Ave N
Ste 101
Myrtle Beach, SC 29577

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John Chadwick Individual Corporate OfficerCfo Oct 1, 2019
Well Care Health, Inc. Organization, Wilmington, NC LLC 5% Or Greater Direct Ownership Interest Nov 30, 2021 100%
Deborah R Chappell Individual W-2 Managing EmployeeDelegated Official Sep 9, 2009
Other Nov 12, 2018
Daniel Thompson Individual Operational/Managerial ControlVP Compliance and Quality Oct 1, 2019
Zachary Long Individual Corporate OfficerCeo Oct 1, 2019
W-2 Managing EmployeeCeo Oct 1, 2019
Long Family Ventures, LLC Organization, Raleigh, NC LLC 5% Or Greater Indirect Ownership Interest Nov 30, 2021 100%

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 119

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 119

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1124536446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 RACINE DR STE 201",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284038752",
            "telephone_number": "910-362-9405",
            "fax_number": "910-202-1376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 48TH AVE N UNIT 101",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775446",
            "telephone_number": "843-712-7095",
            "fax_number": "910-202-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELL CARE HOME HEALTH OF THE LOWCOUNTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-22",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "910-362-9405"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.