Provider Demographics
NPI:1841560182
Name:WELLSPRING FAMILY SERVICES
Entity Type:Organization
Organization Name:WELLSPRING FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:304-242-7060
Mailing Address - Street 1:3200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4725
Mailing Address - Country:US
Mailing Address - Phone:304-748-3768
Mailing Address - Fax:
Practice Address - Street 1:3200 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4725
Practice Address - Country:US
Practice Address - Phone:304-748-3768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRITTENTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health