Provider Demographics
NPI:1619593654
Name:WELLPATH COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:WELLPATH COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-312-7244
Mailing Address - Street 1:1130 CONROY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1130 CONROY LN STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4154
Practice Address - Country:US
Practice Address - Phone:916-580-6600
Practice Address - Fax:916-580-6639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLPATH COMMUNITY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health