Provider Demographics
NPI:1982081352
Name:WELLS CENTER, INC
Entity Type:Organization
Organization Name:WELLS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-243-1871
Mailing Address - Street 1:1300 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3112
Mailing Address - Country:US
Mailing Address - Phone:217-243-7693
Mailing Address - Fax:217-243-2278
Practice Address - Street 1:1300 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3112
Practice Address - Country:US
Practice Address - Phone:217-243-7693
Practice Address - Fax:217-243-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0613-0006-A324500000X
ILA-0613-0008-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========008Medicaid
IL=========006Medicaid