Provider Demographics
NPI:1255087722
Name:WELLSTEAD HEALTH
Entity type:Organization
Organization Name:WELLSTEAD HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-831-2438
Mailing Address - Street 1:75 MARKET ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5040
Mailing Address - Country:US
Mailing Address - Phone:978-831-2438
Mailing Address - Fax:
Practice Address - Street 1:75 MARKET ST STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5040
Practice Address - Country:US
Practice Address - Phone:978-831-2438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLSTEAD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-23
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty