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General NPI Number Information
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NPI Number | 1801429733
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Entity Type | Organization
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Legal Business Name | WELLSPRING HOME HEALTH CENTER, LLC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 8815 S. TACOMA WAY SUITE 120
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City | LAKEWOOD
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State | WA
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Zip | 98499
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Country | US
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Telephone | 253-625-7606
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Fax | 253-625-7079
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Provider Business Mailing Address
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Address Line | P.O. BOX 33064
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City | TACOMA
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State | WA
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Zip | 98433
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Country | US
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Telephone | 253-625-7606
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Fax | 253-625-7079
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERNEST IBANGA SR.
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Credential |
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Telephone | 706-833-9917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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