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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
4343 WILLIAMSBOURGH DRIVE, SACRAMENTO, CA 95823-2006
(916) 395-3552
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
251S00000X
Community/Behavioral Health Agency
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
343425000
CA
Enumeration date
10/25/2006
Last updated
02/25/2020
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