Healthcare Provider Details

I. General information

NPI: 1619593654
Provider Name (Legal Business Name): WELLPATH COMMUNITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 CONROY LN STE 100
ROSEVILLE CA
95661-4154
US

IV. Provider business mailing address

1130 CONROY LN STE 100
ROSEVILLE CA
95661-4154
US

V. Phone/Fax

Practice location:
  • Phone: 916-580-6600
  • Fax: 916-580-6639
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: COLTON CLINE
Title or Position: DIRECTOR
Credential:
Phone: 615-312-7244