Healthcare Provider Details

I. General information

NPI: 1730346339
Provider Name (Legal Business Name): WELLSPRING FARM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 HILLER RD
ROCHESTER MA
02770
US

IV. Provider business mailing address

42 HILLER RD
ROCHESTER MA
02770
US

V. Phone/Fax

Practice location:
  • Phone: 508-763-5896
  • Fax: 508-763-5896
Mailing address:
  • Phone: 508-763-5896
  • Fax: 508-763-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMA
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMA

VIII. Authorized Official

Name: JAMES EDWARD VOGEL
Title or Position: FOUNDER EXECUTIVE DIRECTOR
Credential: MA CAGS LCSW
Phone: 508-763-5896