Provider Demographics
NPI: | 1366138018 |
---|---|
Name: | WELLSPRINGS HOME HEALTH CARE LLC |
Entity type: | Organization |
Organization Name: | WELLSPRINGS HOME HEALTH CARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | DANIELLE |
Authorized Official - Last Name: | DENNIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 410-907-0625 |
Mailing Address - Street 1: | 1340 SMITH AVE STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | MOUNT WASHINGTON |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21209-3796 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-608-9341 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1330 SMITH AVE STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | MOUNT WASHINGTON |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21209-3878 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-907-0622 |
Practice Address - Fax: | 667-239-1001 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | WELLSPRINGS HOME HEALTH CARE |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-04-14 |
Last Update Date: | 2023-04-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |