Provider Demographics
NPI:1174916712
Name:WILLCARE
Entity type:Organization
Organization Name:WILLCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:VERACKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-361-0392
Mailing Address - Street 1:700 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-6416
Mailing Address - Country:US
Mailing Address - Phone:845-561-3655
Mailing Address - Fax:
Practice Address - Street 1:700 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6416
Practice Address - Country:US
Practice Address - Phone:845-561-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY695683251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health