Provider Demographics
NPI:1598164089
Name:WELLSPRING HOSPICE
Entity Type:Organization
Organization Name:WELLSPRING HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/BOARD MEMBER/ADMINISTRATO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-616-3535
Mailing Address - Street 1:19730 VENTURA BLVD STE 25
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6301
Mailing Address - Country:US
Mailing Address - Phone:818-616-3535
Mailing Address - Fax:818-530-9287
Practice Address - Street 1:19730 VENTURA BLVD STE 25
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-6301
Practice Address - Country:US
Practice Address - Phone:818-616-3535
Practice Address - Fax:818-530-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based