Provider Demographics
NPI:1427006907
Name:WELLSPRING WHOLISTIC CARE CENTER
Entity Type:Organization
Organization Name:WELLSPRING WHOLISTIC CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTZEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-925-7002
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:FREEMAN
Mailing Address - State:SD
Mailing Address - Zip Code:57029
Mailing Address - Country:US
Mailing Address - Phone:605-925-7002
Mailing Address - Fax:
Practice Address - Street 1:804 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:FREEMAN
Practice Address - State:SD
Practice Address - Zip Code:57029
Practice Address - Country:US
Practice Address - Phone:605-925-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0007699OtherBC/BS GROUP NUMBER
SD7699Medicare ID - Type UnspecifiedGROUP NUMBER