Organization
WELLSPACE HEALTH
Active
Organization
WELLSPACE HEALTH
Active
Other names
Strategies For Change
Organization subpart
No
Provider details
NPI number
Authorized official
A. JONATHAN PORTEUS PHD (CHIEF EXECUTIVE OFFICER)
(916) 550-5444
Entity
Organization
Contact information
Practice address
4441 AUBURN BLVD, SUITE E, SACRAMENTO, CA 95841-4139
(916) 473-5764
(916) 473-5766
Mailing address
777 12TH STREET, SUITE 250, SACRAMENTO, CA 95814
(916) 550-5444
(916) 436-5527
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
942600143
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343405000
—
CA
Enumeration date
10/31/2006
Last updated
02/25/2020
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