Provider Demographics
NPI:1851253512
Name:WELLSPRING WISCONSIN LLC
Entity type:Organization
Organization Name:WELLSPRING WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ODESKY
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:262-888-3777
Mailing Address - Street 1:6980 N PORT WASHINGTON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3900
Mailing Address - Country:US
Mailing Address - Phone:262-888-3777
Mailing Address - Fax:414-909-8788
Practice Address - Street 1:6980 N PORT WASHINGTON RD STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3900
Practice Address - Country:US
Practice Address - Phone:262-888-3777
Practice Address - Fax:414-909-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care