Provider Demographics
NPI:1851927362
Name:WELLSPRING HOSPICE LLC
Entity Type:Organization
Organization Name:WELLSPRING HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIACCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-970-0733
Mailing Address - Street 1:4006 ROUTE 9 S
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1577
Mailing Address - Country:US
Mailing Address - Phone:732-970-0733
Mailing Address - Fax:
Practice Address - Street 1:7300 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3735
Practice Address - Country:US
Practice Address - Phone:732-970-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based