Healthcare Provider Details

I. General information

NPI: 1417581315
Provider Name (Legal Business Name): WELL SPRING HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 CRATER LAKE AVE
MEDFORD OR
97504-6505
US

IV. Provider business mailing address

1208 BEALL LN
CENTRAL POINT OR
97502-1573
US

V. Phone/Fax

Practice location:
  • Phone: 888-719-3491
  • Fax:
Mailing address:
  • Phone: 888-719-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY HANLEY
Title or Position: PRESIDENT
Credential: NP
Phone: 888-719-3491