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
1320 LANDSDOWN DR, SALISBURY, NC 28147-7373
(980) 330-3432
Mailing address
1320 LANDSDOWN DR, SALISBURY, NC 28147-7373
(980) 330-3432
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346879434
—
NC
Enumeration date
07/10/2020
Last updated
07/10/2020
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