Provider Demographics
NPI:1205042553
Name:WELLSPRING COTTAGE LLC
Entity Type:Organization
Organization Name:WELLSPRING COTTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERR-PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:717-597-2978
Mailing Address - Street 1:2107 CASTLEGREEN DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-9215
Mailing Address - Country:US
Mailing Address - Phone:717-597-2978
Mailing Address - Fax:717-597-3046
Practice Address - Street 1:2107 CASTLEGREEN DR
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-9215
Practice Address - Country:US
Practice Address - Phone:717-597-2978
Practice Address - Fax:717-597-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008131-L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF 12825Medicare UPIN
PA741825Medicare ID - Type Unspecified
741825Medicare PIN
PA111781Medicare PIN