Provider Demographics
NPI:1881948594
Name:WELLSPRING COMPREHENSIVE MANAGEMENT COMPANY, LLC.
Entity type:Organization
Organization Name:WELLSPRING COMPREHENSIVE MANAGEMENT COMPANY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP-C
Authorized Official - Phone:248-224-5316
Mailing Address - Street 1:19785 W 12 MILE RD # 354
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19785 W 12 MILE RD # 354
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2584
Practice Address - Country:US
Practice Address - Phone:248-224-5316
Practice Address - Fax:248-629-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704203961363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty