Healthcare Provider Details

I. General information

NPI: 1811196652
Provider Name (Legal Business Name): WELLSPRING FAITH IN ACTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 8TH ST S
SAINT JAMES MN
56081-1798
US

IV. Provider business mailing address

108 8TH ST S
SAINT JAMES MN
56081-1798
US

V. Phone/Fax

Practice location:
  • Phone: 507-375-1276
  • Fax: 507-375-1260
Mailing address:
  • Phone: 507-375-1276
  • Fax: 507-375-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON JOANN DEXHEIMER
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 507-375-1276