# WELLSPRING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912046202
- **Authorized official:** DEBRA HUMPHREY-KEEVER (CFO)
- **Authorized official phone:** (503) 963-7786

## Contact information

- **Practice address:** 2034 SE 6TH AVE, PORTLAND, OR 97214-4510
- **Practice address phone:** (503) 238-6801
- **Practice address fax:** (503) 238-6810
- **Mailing address:** PO BOX 8459, PORTLAND, OR 97207-8459
- **Mailing address phone:** (503) 238-0769
- **Mailing address fax:** (503) 552-6211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 08/22/2020