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General NPI Number Information
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NPI Number | 1124315932
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Entity Type | Organization
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Legal Business Name | WELLSPRING RESOURCES
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 220 E COUNTY RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-3125
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Country | US
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Telephone | 618-639-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 220 E COUNTY RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-3125
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Country | US
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Telephone | 618-639-2010
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KAREN SOPRONYI-TOMPKINS
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Credential |
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Telephone | 618-462-2331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180.004917
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License Number State | IL
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