Provider Demographics
NPI:1811861610
Name:WIREGRASS HOMECARE
Entity type:Organization
Organization Name:WIREGRASS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-797-9349
Mailing Address - Street 1:172 HONEYSUCKLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1262
Mailing Address - Country:US
Mailing Address - Phone:334-797-9349
Mailing Address - Fax:334-610-3500
Practice Address - Street 1:172 HONEYSUCKLE RD STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1262
Practice Address - Country:US
Practice Address - Phone:334-797-9349
Practice Address - Fax:334-610-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty