Active NPI
Welllife Network Inc.
- Case Management Agency
- Coram, NY
National Provider Identifier
1386817906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Agency
- Legal business name
- WELLLIFE NETWORK INC.
- Practice address
- 3600 Route 112
Coram, NY 11727-4116 - Phone
- (631) 920-8302
- Fax
- (631) 920-8462
- NPI assigned
- Apr 3, 2008
- Last updated
- Aug 16, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sherry Tucker
- Title
- Ceo
- Phone
- (718) 559-0534
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | NU | Primary |
Addresses
Primary practice location
3600 Route 112
Coram, NY 11727-4116
Mailing address
1985 Marcus Ave Ste 100
New Hyde Park, NY 11042-2025
Phone (718) 559-0516
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02189655 | Medicaid | NY |
Other names 1
- PSCH INC.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040311000454 | NY | Part B Supplier - Clinic/Group Practice | 0749179570 |
Receives reassigned benefits from 47 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brooklyn, NY; Wyandanch, NY; Smithtown, NY; Setauket, NY; Queens Village, NY; Huntington, NY; Great Neck, NY; Elmont, NY… |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Promoting Specialized Care Health
Other organizations with this tax ID 24
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Promoting Specialized Care & Health
- Clinic/Center
- South Richmond Hill, NY
- NPI 1841354131
-
- Community/Behavioral Health Agency
- Astoria, NY
- NPI 1124351853
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Brooklyn, NY
- NPI 1417011776
-
- Community/Behavioral Health Agency
- College Point, NY
- NPI 1609029909
-
dba Promoting Specialized Care & Health
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Richmond Hill, NY
- NPI 1265596829
-
dba Promoting Specialized Care & Health
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Brooklyn, NY
- NPI 1316001837
-
dba Promoting Specialized Care & Health
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Flushing, NY
- NPI 1548324171
-
dba Promoting Specialized Care & Health
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Springfield Gardens, NY
- NPI 1578627170
-
dba Promoting Specialized Care & Health
- Mental Illness Intermediate Care Facility
- Brooklyn, NY
- NPI 1659505824
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
Locations
14202 20th Ave
#3
Flushing, NY 11351
15317 Jamaica Ave
Ste 3
Jamaica, NY 11432
Phone (718) 297-1718
20905 Jamaica Ave
Queens Village, NY 11428
Phone (631) 920-8302
11 Route 111
Smithtown, NY 11787
Phone (631) 656-9550
Practitioners & affiliated clinicians
Practitioners 166
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Mental Health Counselor
- Coram, NY
- NPI 1093444101
-
- Mental Health Counselor
- Malverne, NY
- NPI 1871608984
-
- Obstetrics & Gynecology Physician
- Far Rockaway, NY
- NPI 1194902569
-
- Mental Health Counselor
- Smithtown, NY
- NPI 1558513481
-
- Psychiatric/Mental Health Nurse Practitioner
- Coram, NY
- NPI 1427384635
-
- Psychiatric/Mental Health Nurse Practitioner
- Setauket, NY
- NPI 1730891755
Single Specialty
-
- Psychiatric/Mental Health Nurse Practitioner
- Glen Oaks, NY
- NPI 1265552285
-
- Mental Health Counselor
- Flushing, NY
- NPI 1679067540
-
- Clinical Social Worker
- Coram, NY
- NPI 1184188484
-
- Psychiatric/Mental Health Nurse Practitioner
- Brooklyn, NY
- NPI 1720739329
-
- Student in an Organized Health Care Education/Training Program
- Queens Village, NY
- NPI 1205491537
-
- Physical Therapist
- New York, NY
- NPI 1831114925
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207180800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1723766400000",
"number": "1386817906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1985 MARCUS AVE STE 100",
"city": "NEW HYDE PARK",
"state": "NY",
"postal_code": "110422025",
"telephone_number": "718-559-0516",
"fax_number": "718-762-6140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 ROUTE 112",
"city": "CORAM",
"state": "NY",
"postal_code": "117274116",
"telephone_number": "631-920-8302",
"fax_number": "631-920-8462"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLLIFE NETWORK INC.",
"organizational_subpart": "NO",
"enumeration_date": "2008-04-03",
"last_updated": "2024-08-16",
"certification_date": "2024-08-16",
"status": "A",
"authorized_official_last_name": "TUCKER",
"authorized_official_first_name": "SHERRY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "718-559-0534"
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02189655",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PSCH INC.",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Coram, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.