Provider Demographics
NPI:1851059208
Name:WELLSPRING, INC.
Entity Type:Organization
Organization Name:WELLSPRING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:DEETT
Authorized Official - Last Name:KRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-718-4870
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-1087
Mailing Address - Country:US
Mailing Address - Phone:605-718-4870
Mailing Address - Fax:
Practice Address - Street 1:22 WATERLOO ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1656
Practice Address - Country:US
Practice Address - Phone:605-718-4870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6057184870Medicaid