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General NPI Number Information
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NPI Number | 1154475184
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Entity Type | Organization
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Legal Business Name | THE WELLSPRING FOUNDATION, INC.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 21 ARCH BRIDGE RD.
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City | BETHLEHEM
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State | CT
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Zip | 06751-0370
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Country | US
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Telephone | 203-266-8000
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Fax | 203-266-8030
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Provider Business Mailing Address
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Address Line | 21 ARCH BRIDGE RD. P.O. BOX 370
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City | BETHLEHEM
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State | CT
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Zip | 06751-0370
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Country | US
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Telephone | 203-266-8000
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Fax | 203-266-8030
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. HARVEY NEWMAN
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Credential | M.ED
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Telephone | 203-266-8110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | CCF RT 26
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License Number State | CT
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