Organization
COMPLETE WELL-CARE SOURCE LLC
Active
Other names
Complete Well-Care Source LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MYRA VAUGHTERS WILSON (CEO)
(336) 682-8968
Entity
Organization
Contact information
Practice address
512 KLUMAC RD STE 9, SALISBURY, NC 28144-6752
(980) 305-2003
(980) 243-0660
Mailing address
1320 LANDSDOWN DR, SALISBURY, NC 28147-7373
(980) 305-2003
(980) 340-3432
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124646328
—
NC
05
—
1952929408
—
NC
Enumeration date
07/14/2020
Last updated
10/23/2024
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