Healthcare Provider Details

I. General information

NPI: 1427149434
Provider Name (Legal Business Name): SPRINGWELL NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2588 BRANDYWINE ROAD
WINSTON SALEM NC
27103-6602
US

IV. Provider business mailing address

3820 NORTH PATTERSON AVENUE
WINSTON SALEM NC
27105
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-6601
  • Fax: 336-831-1314
Mailing address:
  • Phone: 336-831-1300
  • Fax: 336-831-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-034-362
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-034-362
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL034147
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-034-362
License Number StateNC

VIII. Authorized Official

Name: MS. CHARLENE WARREN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-831-1300