Provider Demographics
NPI:1790468882
Name:WELLSPRING HEALTHCARE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:WELLSPRING HEALTHCARE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:NKECHI
Authorized Official - Last Name:SONEYE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-252-0054
Mailing Address - Street 1:8470 WINDING TRL
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1427
Mailing Address - Country:US
Mailing Address - Phone:240-252-0054
Mailing Address - Fax:
Practice Address - Street 1:8470 WINDING TRL
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1427
Practice Address - Country:US
Practice Address - Phone:240-252-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health