Provider Demographics
NPI:1982191490
Name:WELLSPRINGS OF PHOENIX LLC
Entity Type:Organization
Organization Name:WELLSPRINGS OF PHOENIX LLC
Other - Org Name:WELLSPRINGS THERAPY CENTER OF PHOENIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-640-4921
Mailing Address - Street 1:5664 KODIAK WAY
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7767
Mailing Address - Country:US
Mailing Address - Phone:435-640-4921
Mailing Address - Fax:
Practice Address - Street 1:3008 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3002
Practice Address - Country:US
Practice Address - Phone:602-313-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility