Provider Demographics
NPI:1023493269
Name:WELLSPRING HOME HEALTH CENTER, LLC
Entity type:Organization
Organization Name:WELLSPRING HOME HEALTH CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:IBANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-833-9917
Mailing Address - Street 1:PO BOX 872903
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-2903
Mailing Address - Country:US
Mailing Address - Phone:907-357-3655
Mailing Address - Fax:907-357-3656
Practice Address - Street 1:609 S KNIK GOOSE BAY RD STE K
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8079
Practice Address - Country:US
Practice Address - Phone:907-356-3655
Practice Address - Fax:907-357-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health