Provider Demographics
NPI:1750798054
Name:WELLSPRING RESOURCES
Entity type:Organization
Organization Name:WELLSPRING RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOPRONYI-TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:618-208-2221
Mailing Address - Street 1:221 E COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-3190
Mailing Address - Country:US
Mailing Address - Phone:618-639-2010
Mailing Address - Fax:618-639-2015
Practice Address - Street 1:221 E COUNTY RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-3190
Practice Address - Country:US
Practice Address - Phone:618-639-2010
Practice Address - Fax:618-639-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========014Medicaid
IL=========014Medicaid