| Wellspring, Inc. | |
|
253-255 Hammond St. Bangor ME 04401 | |
| (207) 941-1612 | |
| (207) 941-1634 |
| Full Name | Wellspring, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 253-255 Hammond St., Bangor, Maine |
| Authorized Official Name and Position | Patricia A Kimball (EXECUTIVE DIRECTOR REGISTERED AGENT) |
| Authorized Official Contact | 2079411612 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring, Inc. 98 Cumberland St Bangor ME 04401-5234 Ph: () - | Wellspring, Inc. 253-255 Hammond St. Bangor ME 04401 Ph: (207) 941-1612 |
| NPI Number | 1568694511 |
|---|---|
| Provider Enumeration Date | 08/10/2009 |
| Last Update Date | 08/10/2009 |
| Medicare PECOS PAC ID | 8527236223 |
|---|---|
| Medicare Enrollment ID | O20110725000495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568694511 | NPI | - | NPPES |
| 164940100 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 571380 (Maine) | Primary |
| Provider Name | Richard D Bissell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255453361 PECOS PAC ID: 6507887247 Enrollment ID: I20051214000226 |
| Provider Name | Sarah J Falvey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760703870 PECOS PAC ID: 0648415513 Enrollment ID: I20130325000232 |
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