NPIMap

Organization Active NPI

Well Care Hospice, Inc

  • Community Based Hospice Care Agency
  • Advance, NC
National Provider Identifier
1679081996
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HOS4966 Issued in NC
Legal business name
WELL CARE HOSPICE, INC
Practice address
146A Dornach Way
Advance, NC 27006-7305
Phone
(336) 753-6200
Fax
(336) 751-9287
NPI assigned
Jan 22, 2018
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
Community Based Hospice Care Agency 251G00000X HOS4966 NC Primary

Addresses

Primary practice location

146A Dornach Way
Advance, NC 27006-7305

Mailing address

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

Other practice location 1

6752 Parker Farm Dr
Wilmington, NC 28405-3175
Phone (910) 362-9405

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190321002618 NC Part A Provider - Hospice 4981944394 Practice locations: Advance, NC

Hospice certification: CCN 341603

Legal name
WELL CARE HOSPICE, INC.
Doing business as
WELL CARE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 4, 2019
Last certification
Dec 4, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Sep 5, 2017 in NC
Enrollment address
146A Dornach Way
Advance, NC 27006-7305

Care Compare: Hospice

Medicare Care Compare
Listed as
Well Care Hospice, Inc.CCN 341603
Ownership
For-Profit
Certified
Dec 4, 2019
Medicare certification status
ActiveFrom the Provider of Services file

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
34D2162454Well Care Hospice, Inc146A Dornach Way, Advance, NC 27006Certificate of waiverFeb 21, 2027

National Provider Directory

National Provider Directory

Locations

146 Dornach Way
#A
Advance, NC 27006
Phone (336) 753-6200

5380 US Highway 158
Ste 210
Advance, NC 27006

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

Ownership & related parties

All disclosed owners & managing parties 5

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 DirectorChief Financial Officer Sep 1, 2019
Well Care Health, Inc. Organization, Wilmington, NC Corporation 5% Or Greater Direct Ownership Interest Mar 17, 2017 100%
Daniel Thompson Individual W-2 Managing EmployeeVP Compliance and Quality Nov 30, 2021
Operational/Managerial ControlVP Compliance Quality Nov 30, 2021
OtherVP Compliance and Quality Sep 1, 2019
Zachary Long Individual Corporate OfficerChief Executive Officer Sep 5, 2017
W-2 Managing EmployeeChief Executive Officer 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.

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": "1679081996",
    "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": "146A DORNACH WAY",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270067305",
            "telephone_number": "336-753-6200",
            "fax_number": "336-751-9287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6752 Parker Farm Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284053175",
            "country_code": "US",
            "telephone_number": "910-362-9405",
            "fax_number": "910-362-9948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WELL CARE HOSPICE, INC",
        "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": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NC",
            "license": "HOS4966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Advance, NC

Sources for this page

Verify at the official NPI Registry.