MEDICARE: WELLSPRING HEALTHCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1699105270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING HEALTHCARE INC

Provider Business Mailing Address
First Line	:	3706 QUIET PLACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-1219
Country	:	US
Telephone Number	:	713-449-1133
Fax Number	:	713-449-1133

Provider Business Practice Location Address
First Line	:	3706 QUIET PLACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-1219
Country	:	US
Telephone Number	:	713-449-1133
Fax Number	:	713-449-1133

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANTHONIA ODUSANYA
Credential	:
Telephone Number	:	713-449-1133

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	02/06/2014

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