Provider Demographics
NPI:1073311783
Name:WELLSPRING HOME LLC
Entity type:Organization
Organization Name:WELLSPRING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GIKUNDIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGAGAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-235-1177
Mailing Address - Street 1:320 16TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2830
Mailing Address - Country:US
Mailing Address - Phone:309-235-1177
Mailing Address - Fax:
Practice Address - Street 1:320 16TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2830
Practice Address - Country:US
Practice Address - Phone:309-235-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities