Healthcare Provider Details

I. General information

NPI: 1649947110
Provider Name (Legal Business Name): WELLSPRING CASE MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42245 ANN ARBOR RD E STE 103
PLYMOUTH MI
48170-4311
US

IV. Provider business mailing address

PO BOX 5576
PLYMOUTH MI
48170-5576
US

V. Phone/Fax

Practice location:
  • Phone: 734-453-1743
  • Fax:
Mailing address:
  • Phone: 734-453-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JOYCE MAUK
Title or Position: PRESIDENT/OWNER
Credential: BA BSN RN CNLCP
Phone: 734-453-1743