Provider Demographics
NPI:1093740573
Name:WELLSPRING FAMILY SERVICES
Entity Type:Organization
Organization Name:WELLSPRING FAMILY SERVICES
Other - Org Name:WELLSPRING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:425-826-3035
Mailing Address - Street 1:1900 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4606
Mailing Address - Country:US
Mailing Address - Phone:206-826-3050
Mailing Address - Fax:877-903-0711
Practice Address - Street 1:1900 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4606
Practice Address - Country:US
Practice Address - Phone:206-826-3050
Practice Address - Fax:877-903-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB27800Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
WAGAB27802Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
WAGAB27773Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
WAGAB27799Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
WAGAB27801Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER