| Organization Name: | WELLSPRING HOSPICE |
| NPI Number: | 1598164089 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRICO REYES (PRESIDENT) |
| Mailing Address: | 14640 Victory Blvd Suite 215 Van Nuys |
| State: | CA US |
| Postal Code: | 914111623 |
| Phone Number: | 8184159619 |
| Fax Number: | 8185309287 |
| NPI Enumeration Date: | 08/20/2014 |
| NPI Last Update Date: | 12/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |