Complete Well-Care Source LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

COMPLETE WELL-CARE SOURCE LLC

Practice address

512 Klumac Rd Ste 9
Salisbury, NC 28144-6752

Phone

(980) 305-2003

Fax

(980) 243-0660

NPI assigned

Jul 14, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Myra Vaughters WilsonNPI 1346879434

Title

Ceo

Phone

(336) 682-8968

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Complete Well-Care Source LLC Other name

Electronic endpoints 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Myra Vaughters Wilson

  • Case Manager/Care Coordinator
  • Salisbury, NC
  • NPI 1346879434
  NPD Authorized official

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1124646328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 LANDSDOWN DR",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281477373",
            "telephone_number": "980-305-2003",
            "fax_number": "980-340-3432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 KLUMAC RD STE 9",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281446752",
            "telephone_number": "980-305-2003",
            "fax_number": "980-243-0660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1320 Landsdown Dr",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "NC",
            "postal_code": "281477373",
            "country_code": "US",
            "telephone_number": "336-682-8968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMPLETE WELL-CARE SOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-14",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MYRA",
        "authorized_official_middle_name": "VAUGHTERS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-682-8968",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124646328",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952929408",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "LAN",
            "affiliation": "N",
            "address_1": "1320 Landsdown Dr",
            "city": "Salisbury",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281477373",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https",
            "affiliation": "N",
            "endpointDescription": "Desktop/Laptop",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "512 Klumac Rd Ste 9",
            "city": "Salisbury",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281446752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Complete Well-Care Source LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Complete Well-Care Source LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.