20D2269650 CLIA NUMBER - WELLSPRING, INC

Laboratory Demographics

  • CLIA Code: 20D2269650
  • Facility Name: WELLSPRING, INC
  • Facility Address: 319 STATE STREET
    BANGOR, ME
    ZIP 04401
  • Facility Phone: 207 941-1639
  • Facility Type: Other - SUD RESIDENTIAL PNMI
  • Facility Type: Waiver
  • Lab Director: RAYMOND BAXTER
  • NPI Number: 1568694511
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 20D2269650
LAB Type Other - SUD RESIDENTIAL PNMI
Facility Name WELLSPRING, INC
Street 319 STATE STREET
City BANGOR
State ME
ZIP 04401
Phone 207 941-1639
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2024
Certificate Expiration Date 9/29/2026
Facility Type Other - SUD RESIDENTIAL PNMI
Lab Director RAYMOND BAXTER

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This page was last updated on: 3/20/2025