Provider Demographics
NPI:1760899298
Name:WELLSPRING ADDICTION RECOVERY LLC
Entity Type:Organization
Organization Name:WELLSPRING ADDICTION RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSCOE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:412-478-6736
Mailing Address - Street 1:7707 FANNIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1926
Mailing Address - Country:US
Mailing Address - Phone:412-434-6700
Mailing Address - Fax:412-434-6710
Practice Address - Street 1:7707 FANNIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1926
Practice Address - Country:US
Practice Address - Phone:412-434-6700
Practice Address - Fax:412-434-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty