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General NPI Number Information
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NPI Number | 1205933561
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Entity Type | Organization
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Legal Business Name | WELLS CENTER INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1300 LINCOLN AVENUE
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City | JACKSONVILLE
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State | IL
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Zip | 62650
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Country | US
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Telephone | 217-243-1871
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Fax | 217-243-2278
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Provider Business Mailing Address
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Address Line | 1300 LINCOLN AVENUE
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City | JACKSONVILLE
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State | IL
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Zip | 62650
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Country | US
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Telephone | 217-243-1871
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Fax | 217-243-2278
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BRUCE M CARTER
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Credential | MPA CRADC ICADC
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Telephone | 217-243-1871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A0613007A
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License Number State | IL
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