Provider Demographics
NPI:1669095014
Name:WELL-SPRING HOME CARE LLC
Entity type:Organization
Organization Name:WELL-SPRING HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVA
Authorized Official - Middle Name:SIMPSON
Authorized Official - Last Name:CROMARTIE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:336-545-5456
Mailing Address - Street 1:4100 WELL SPRING DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRESSNBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410
Mailing Address - Country:US
Mailing Address - Phone:336-454-5352
Mailing Address - Fax:336-282-3020
Practice Address - Street 1:3859 BATTLEGROUND AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-545-5446
Practice Address - Fax:363-282-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care