Provider Demographics
NPI:1447704143
Name:WECARE TLC - TITAN FAMILY WELLNESS CENTER
Entity type:Organization
Organization Name:WECARE TLC - TITAN FAMILY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NATION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-941-0644
Mailing Address - Street 1:910 BROADWAY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2729
Mailing Address - Country:US
Mailing Address - Phone:217-919-9057
Mailing Address - Fax:217-666-4084
Practice Address - Street 1:910 BROADWAY ST
Practice Address - Street 2:SUITE D
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2729
Practice Address - Country:US
Practice Address - Phone:217-919-9057
Practice Address - Fax:217-666-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care