Healthcare Provider Details

I. General information

NPI: 1851253512
Provider Name (Legal Business Name): WELLSPRING WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6980 N PORT WASHINGTON RD STE 204
GLENDALE WI
53217-3900
US

IV. Provider business mailing address

6980 N PORT WASHINGTON RD STE 204
GLENDALE WI
53217-3900
US

V. Phone/Fax

Practice location:
  • Phone: 262-888-3777
  • Fax: 414-909-8788
Mailing address:
  • Phone: 262-888-3777
  • Fax: 414-909-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LAUREN ODESKY
Title or Position: CEO
Credential: CSA
Phone: 262-888-3777