Healthcare Provider Details

I. General information

NPI: 1124544937
Provider Name (Legal Business Name): WELLSPACE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 WILLIAMSBOURGH DR
SACRAMENTO CA
95823-2006
US

IV. Provider business mailing address

777 12TH ST STE 250
SACRAMENTO CA
95814-1929
US

V. Phone/Fax

Practice location:
  • Phone: 916-395-3552
  • Fax: 916-395-3683
Mailing address:
  • Phone: 916-550-5481
  • Fax: 916-520-3921

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: DR. ALASDAIR JONATHAN PORTEUS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 916-313-8413