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Organization

WELLSPRING FARM LLC

Active
Other names
Wellspring Farm Learning Center
Organization subpart
No

Provider details

NPI number
Authorized official
JAMES EDWARD VOGEL MA CAGS LCSW (FOUNDER EXECUTIVE DIRECTOR)
(508) 763-5896
Entity
Organization

Contact information

Practice address
42 HILLER RD, ROCHESTER, MA 02770
(508) 763-5896
(508) 763-5896
Mailing address
42 HILLER RD, ROCHESTER, MA 02770
(508) 763-5896
(508) 763-5896

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
MA
163W00000X
Registered Nurse
MA
208000000X
Pediatrics Physician
MA
225100000X
Physical Therapist
MA
225X00000X
Occupational Therapist
MA
235Z00000X
Speech-Language Pathologist
MA
251S00000X
Community/Behavioral Health Agency
Primary
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0038463
COMMUNITY MEDICAL ALLIANCE
MA
05
1016266
MA
01
VCG000188774AD
MA STATE VENDOR
MA
01
WWELL001A
MA DMR AUTISM WAIVER NUMBER
MA
Enumeration date
05/21/2008
Last updated
05/21/2008
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