Organization
WELLSPRING, INC.
Active
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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