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General NPI Number Information
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NPI Number | 1972110088
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Entity Type | Organization
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Legal Business Name | WYNSPRING FAMILY RESOURCE CENTER
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 2211 PARK TOWNE CIR STE 4
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City | SACRAMENTO
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State | CA
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Zip | 95825-0414
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Country | US
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Telephone | 916-480-0280
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Fax | 916-480-0282
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Provider Business Mailing Address
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Address Line | PO BOX 71
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95611-0071
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Country | US
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Telephone | 916-480-0280
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Fax | 916-480-0282
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DE J KOVILL
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Credential |
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Telephone | 916-480-0280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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