Healthcare Provider Details

I. General information

NPI: 1245794064
Provider Name (Legal Business Name): WELLSPACE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 FREEPORT BLVD
SACRAMENTO CA
95818-4349
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 916-264-4400
  • Fax:
Mailing address:
  • Phone: 916-550-5481
  • 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: ALASDAIR JONATHAN PORTEUS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 916-550-5444