Provider Demographics
NPI:1669145405
Name:WELLSPRINGS HEALTH LLC
Entity type:Organization
Organization Name:WELLSPRINGS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NURSE PRA
Authorized Official - Prefix:MISS
Authorized Official - First Name:IFEJOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLORUNFEMI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:646-872-1822
Mailing Address - Street 1:9534 MARY GENEVA LN
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6984
Mailing Address - Country:US
Mailing Address - Phone:646-872-1822
Mailing Address - Fax:
Practice Address - Street 1:1055 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8317
Practice Address - Country:US
Practice Address - Phone:410-321-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)