Provider Demographics
NPI:1811196652
Name:WELLSPRING FAITH IN ACTION
Entity Type:Organization
Organization Name:WELLSPRING FAITH IN ACTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:DEXHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-375-1276
Mailing Address - Street 1:108 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-1798
Mailing Address - Country:US
Mailing Address - Phone:507-375-1276
Mailing Address - Fax:507-375-1260
Practice Address - Street 1:108 8TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1798
Practice Address - Country:US
Practice Address - Phone:507-375-1276
Practice Address - Fax:507-375-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle