Provider Demographics
NPI:1487002515
Name:WELLS HOUSE, INC
Entity Type:Organization
Organization Name:WELLS HOUSE, INC
Other - Org Name:GALE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEYHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-739-7748
Mailing Address - Street 1:124 E BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6104
Mailing Address - Country:US
Mailing Address - Phone:301-739-7748
Mailing Address - Fax:301-739-4001
Practice Address - Street 1:425-427 E PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-0000
Practice Address - Country:US
Practice Address - Phone:301-739-7748
Practice Address - Fax:301-739-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD605783261QR0405X
MD905783324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD532205700Medicaid
MD532205701Medicaid