Wellness Care Center of Irving, LTD

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

WELLNESS CARE CENTER OF IRVING, LTD

Practice address

111 Ferguson CT
Irving, TX 75062-7014

Phone

(972) 353-5437

Fax

(800) 669-2161

NPI assigned

Aug 11, 2017

Organization subpart

No

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

Authorized official

Name

Deborah Diane Durham

Title

Administrator

Phone

(469) 831-2541

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Comprehensive outpatient rehabilitation facility certification: CCN 454884

Legal name

WELLNESS CARE CENTER OF IRVING LTD

Certification status

Active

Provider type (POS)

Comprehensive outpatient rehabilitation facility

Participating since

Oct 19, 2011

Last certification

Feb 23, 2016

Ownership / control type

Proprietary

Most recent change of ownership

Aug 1, 2017

Facility address

111 Ferguson CT Ste 100
Irving, TX 75062

Locations

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1861917734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 FERGUSON CT",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750627014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 FERGUSON CT",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750627014",
            "telephone_number": "972-353-5437",
            "fax_number": "800-669-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS CARE CENTER OF IRVING, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-11",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "DURHAM",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "469-831-2541"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287022201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Comprehensive Outpatient Rehabilitation Facility (CORF) in Irving, TX
• Providers in Irving, TX by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.