Organization
WELLCARE OF NEW JERSEY, INC.
Active
Other names
Wellcare Home Mobility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL JACKSON (PRESIDENT)
(973) 777-3196
Entity
Organization
Contact information
Practice address
410 GARIBALDI AVE, UNIT B, LODI, NJ 07644-3710
(973) 777-3196
(973) 777-3195
Mailing address
410 GARIBALDI AVE, UNIT B, LODI, NJ 07644-3710
(973) 777-3196
(973) 777-3195
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3000007639
PA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009640730001
—
PA
05
—
8866309
—
NJ
Enumeration date
11/08/2005
Last updated
07/21/2022
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