Provider Demographics
NPI:1942569686
Name:WELLSPRINGS CARE AND REHAB
Entity Type:Organization
Organization Name:WELLSPRINGS CARE AND REHAB
Other - Org Name:WELLSPRINGS THERAPY CENTER OF GILBERT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMILLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, CCC-SLP
Authorized Official - Phone:602-639-4730
Mailing Address - Street 1:3319 S. MERCY ROAD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297
Mailing Address - Country:US
Mailing Address - Phone:480-729-6900
Mailing Address - Fax:480-353-2945
Practice Address - Street 1:3319 S. MERCY ROAD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-729-6900
Practice Address - Fax:480-353-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-219314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035285Medicare Oscar/Certification