WELLSPRING, INC. (NPI# 1568694511) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568694511 |
| Entity Type | Organization |
| Organization Name | WELLSPRING, INC. |
| Practice Address |
253-255 Hammond St. Bangor ME 04401 |
| Mailing Address |
98 Cumberland St Bangor ME 04401-5234 |
| Practice Telephone | 2079411612 |
| Practice Fax Number | 2079411634 |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2009-08-10 |
| Authorized Official Name | MRS. PATRICIA A KIMBALL (EXECUTIVE DIRECTOR REGISTERED AGENT) |
| Authorized Official Telephone | 2079411612 |
| Authorized Official Credential | LADC, CCS |
| Is Organization Subpart | Y |
| Parent Organization Name | WELLSPRING, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 571380 | ME | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | 164940100 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295090082 | Wellspring, Inc. | Substance Abuse Rehabilitation Facility | 1205 E Saint James St, Rapid City, SD 57701-3958 | 2012-07-09 |
| 1275526303 | Wellspring, Inc. | Community/Behavioral Health | 255 Hammond St., Bangor, ME 04401-5294 | 2005-08-24 |
| 1508254699 | Wellspring, Inc. | Substance Abuse Rehabilitation Facility | 98 Cumberland St, Bangor, ME 04401-5234 | 2014-12-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | WELLSPRING, INC. | Arch Bridge Rd, Bethlehem, CT 06751 |
| Massachusetts Corporations | WELLSPRING, INC. | 814 Nantasket Ave., Hull, MA 02045 |
| Street Address |
253-255 HAMMOND ST. |
| City | BANGOR |
| State | ME |
| Zip Code | 04401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750475521 | Maureen A Sylvain | Counselor | 253-255 Hammond St., Bangor, ME 04401 | 2006-10-03 |
| 1043441140 | Larry Allen Tyler | Counselor | 253-255 Hammond St., Bangor, ME 04401 | 2009-08-06 |
| 1407087505 | Jane Marie Irish | Counselor | 253-255 Hammond St., Bangor, ME 04401 | 2009-08-06 |
| 1790916898 | Deborah J Bailly | Counselor | 253-255 Hammond St., Bangor, ME 04401 | 2009-08-06 |
| 1235360330 | Bruce A Campbell | Counselor | 253-255 Hammond St., Bangor, ME 04401 | 2009-08-06 |
| 1144451246 | Mary Ann Combs | Counselor | 253-255 Hammond St., Bangor, ME 04401 | 2009-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1053961300 | Erika Dean | Occupational Therapist | 84 Sylvan Rd., Bangor, ME 04401 | 2019-09-18 |
| 1942853635 | Wildworks Therapy, Pllc | Occupational Therapist | 123 Mt Hope Ave, Bangor, ME 04401 | 2019-07-22 |
| 1255999173 | Jessica Arbisi | Physician Assistant | 1 Northeast Drive, Bangor, ME 04401 | 2019-06-05 |
| 1699232041 | Ehab Khamis Elhefnawi | Anesthesiology | Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 | 2019-02-21 |
| 1477028884 | Zvorufura Makura | Otolaryngology | 885 Union Street, Ste 145, Bangor, ME 04401 | 2018-10-11 |
| 1255826541 | Lindsey M Fields | Optometrist | 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 | 2018-06-28 |
| 1992211338 | Debra J Mcintyre | Counselor | 157 Park Street, #5, Bangor, ME 04401 | 2017-12-21 |
| Find all providers in zip 04401 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629530530 | Fraser Clinical Consultation Services, LLC | Community/Behavioral Health | 96 Harlow St Ste 214, Bangor, ME 04401-4981 | 2019-04-01 |
| 1134632870 | Penobscot Community Health Center | Community/Behavioral Health | 85 Hammond St, Bangor, ME 04401-4913 | 2017-11-15 |
| 1548512114 | Communty Care | Community/Behavioral Health | 40 Summer, Community Care, Bangor, ME 04401-3105 | 2012-10-08 |
| 1285906412 | Families United | Community/Behavioral Health | 304 Hancock St. Suite 2c, Bangor, ME 04401 | 2012-02-03 |
| 1841436128 | Bangor Health Center | Community/Behavioral Health | 803 West Arlington Street, Bangor, MI 49013-1108 | 2008-12-17 |
| 1215102850 | Cornerstone Behavioral Healthcare, LLC | Community/Behavioral Health | 157 Park Street, Suite 5, Bangor, ME 04401-5000 | 2008-04-24 |
| 1629252895 | Van Buren Cass District Health Department | Community/Behavioral Health | 803 West Arlington, Bangor Health Center, Bangor, MI 49013 | 2007-12-24 |
| 1770799306 | Metro Treatment of Maine Lp | Community/Behavioral Health | 659 Hogan Rd, Bangor, ME 04401-3626 | 2007-05-14 |
| 1437370277 | Care Development of Maine | Community/Behavioral Health | 51 4th St, Bangor, ME 04401-6140 | 2007-05-01 |
| 1851432041 | New Life Mission | Community/Behavioral Health | 202 Exchange St, Bangor, ME 04401-6508 | 2007-02-09 |
| Find all providers in BANGOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.