Organization
WELLSPRING, INC.
Active
Other names
Wellspring
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA A. KIMBALL L.A.D.C., C.C.S. (EXECUTIVE DIRECTOR REGISTERED AGENT)
(207) 941-1612
Entity
Organization
Contact information
Practice address
255 HAMMOND ST., BANGOR, ME 04401-5294
(207) 941-1612
(207) 941-1634
Mailing address
98 CUMBERLAND ST, BANGOR, ME 04401-5234
(207) 941-1612
(207) 941-1634
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
291041
ME
324500000X
Substance Abuse Rehabilitation Facility
Primary
290961
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164940000
—
ME
05
—
164940001
—
ME
05
—
164940002
—
ME
05
—
164940003
—
ME
05
—
164940100
—
ME
Enumeration date
08/24/2005
Last updated
08/17/2018
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