Provider Demographics
NPI:1952640450
Name:WELLSPRING NURSING SERVICES, LLC
Entity Type:Organization
Organization Name:WELLSPRING NURSING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-853-9012
Mailing Address - Street 1:1601 N AZTEC ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1105
Mailing Address - Country:US
Mailing Address - Phone:928-853-9012
Mailing Address - Fax:928-527-0616
Practice Address - Street 1:1601 N AZTEC ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1105
Practice Address - Country:US
Practice Address - Phone:928-853-9012
Practice Address - Fax:928-527-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN063697251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care