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
1	251S00000X	Community/Behavioral Health Agency		CA

General Provider Information

NPI Number	:	1700392529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPACE HEALTH

Provider Business Mailing Address
First Line	:	777 12TH ST STE 250
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-1929
Country	:	US
Telephone Number	:	916-469-4690
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 BROADWAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-3301
Country	:	US
Telephone Number	:	916-277-6600
Fax Number	:	916-395-3683

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ALASDAIR JONATHAN PORTEUS
Credential	:	PHD
Telephone Number	:	916-550-5444

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	12/15/2017

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Directions to “WELLSPACE HEALTH ” Practice Location

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