MEDICARE: SPRINGWELL NETWORK, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MHL-034-367	NC
2	311ZA0620X	Adult Care Home Facility	MHL-034-367	NC
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL034152	NC
4	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-034-367	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043308612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGWELL NETWORK, INC.

Provider Business Mailing Address
First Line	:	3820 NORTH PATTERSON AVENUE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105
Country	:	US
Telephone Number	:	336-831-1300
Fax Number	:	336-831-1314

Provider Business Practice Location Address
First Line	:	3250 STOCKTON STREET
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-4843
Country	:	US
Telephone Number	:	336-788-5768
Fax Number	:	336-831-1314

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. CHARLENE WARREN
Credential	:
Telephone Number	:	336-831-1300

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	02/19/2018

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Directions to “SPRINGWELL NETWORK, INC. ” Practice Location

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