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General NPI Number Information
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NPI Number | 1760899298
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Entity Type | Organization
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Legal Business Name | WELLSPRING ADDICTION RECOVERY LLC
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 7707 FANNIN ST SUITE 207
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City | HOUSTON
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State | TX
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Zip | 77054-1926
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Country | US
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Telephone | 412-434-6700
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Fax | 412-434-6710
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Provider Business Mailing Address
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Address Line | 7707 FANNIN ST SUITE 207
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City | HOUSTON
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State | TX
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Zip | 77054-1926
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Country | US
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Telephone | 412-434-6700
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Fax | 412-434-6710
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Authorized Official
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Title or Position | CEO
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Name | GREGORY ROSCOE
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Credential | MHA
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Telephone | 412-478-6736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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