1851501530 NPI number — WELLSPRING MULTIDISCIPLINARY HEALTH AND EDUCATION PROJECT INC

Table of content: (NPI 1851501530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851501530 NPI number — WELLSPRING MULTIDISCIPLINARY HEALTH AND EDUCATION PROJECT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSPRING MULTIDISCIPLINARY HEALTH AND EDUCATION PROJECT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WELLSPRING MENTAL HEALTH AND WELLNESS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851501530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 147
Provider Second Line Business Mailing Address:
39 CHURCH ST
Provider Business Mailing Address City Name:
HARDWICK
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05843-0147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-472-6694
Provider Business Mailing Address Fax Number:
802-472-6694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 CHURCH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDWICK
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05843-0147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-472-6694
Provider Business Practice Location Address Fax Number:
802-472-6694
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCGUIRE
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-472-6694

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TA0700X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0200X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0100X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TM1800X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP2701X , with the licence number: VT 509 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1008971 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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