Basic Information
| Provider Information | |||||||||
| NPI: | 1710379235 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLSPRING HEALTH OF CA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WINDY RIDGE PKWY SE | ||||||||
| Address2: | #210S | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303395665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788130505 | ||||||||
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| Practice Location | |||||||||
| Address1: | WARREN CONFERENCE SERVICE CTR | ||||||||
| Address2: | 9450 GILMAN DRIVE | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920920100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199483942 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | TOWNSEND | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF RCM | ||||||||
| AuthorizedOfficialTelephone: | 4704401647 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RIVERMEND HEALTH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.