Provider Demographics
NPI:1194080309
Name:WELLSPRING EARLY INTERVENTION
Entity type:Organization
Organization Name:WELLSPRING EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-426-7700
Mailing Address - Street 1:25 ROBERT PITT DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3366
Mailing Address - Country:US
Mailing Address - Phone:845-426-7700
Mailing Address - Fax:845-426-7766
Practice Address - Street 1:25 ROBERT PITT DR STE 106
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3366
Practice Address - Country:US
Practice Address - Phone:845-426-7700
Practice Address - Fax:845-426-7766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST MEDCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-13
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency