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NPI Code Detail

MEDICARE: WELLSPACE HEALTH

MEDICARE: WELLSPACE HEALTH
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
1171W00000XContractor
2171M00000XCase Manager/Care Coordinator
3251B00000XCase Management Agency
4251C00000XDevelopmentally Disabled Services Day Training Agency
5251X00000XSupports Brokerage Agency
6261Q00000XClinic/Center030000139CA
7261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
8332U00000XHome Delivered Meals
93747P1801XPersonal Care Attendant
10385H00000XRespite Care
11261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZR11729FOTHERCAPROVIDER NUMBER
2EAP11729FOTHERCAPROVIDER NUMBER

General Provider Information

NPI Number : 1124112933
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLSPACE HEALTH
Provider Business Mailing Address
First Line : 1820 J ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95811-3010
Country : US
Telephone Number : 916-550-5481
Fax Number : 916-822-8974
Provider Business Practice Location Address
First Line : 1820 J ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95811-3010
Country : US
Telephone Number : 916-737-5555
Fax Number : 916-444-5620
Authorized Official
Title or Position : CEO
Name : DR. ALASDAIR JONATHAN PORTEUS
Credential : PHD
Telephone Number : 916-737-5555
Provider Enumeration Date : 10/03/2006
Last Update Date : 03/23/2022

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Directions to “WELLSPACE HEALTH ” Practice Location

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