NPIMap

Organization Active NPI

Wellmore, Inc

Doing business as Wellmore, Inc.-Therapeutic Shelter

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waterbury, CT
National Provider Identifier
1336407915
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
WELLMORE, INC
Doing business as
Wellmore, Inc.-Therapeutic Shelter
Practice address
142 Griggs St
Waterbury, CT 06704-3110
Phone
(203) 574-1419
Fax
(203) 578-4180
NPI assigned
May 2, 2012
Last updated
Jun 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary Steck, LMFTNPI 1760728349
Title
Chief Executive Officer
Phone
(203) 574-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

142 Griggs St
Waterbury, CT 06704-3110

Mailing address

141 E Main St
Waterbury, CT 06702-1701
Phone (203) 574-9000

Other identifiers 1

IdentifierTypeStateIssuer
004039202MedicaidCT

Other names 1

  • Wellmore, Inc.-Therapeutic Shelter Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120828000409 CT Part B Supplier - Clinic/Group Practice 9931356888 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waterbury, CT

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

  • Wellmore, Inc

    dba Wellmore, Inc.-Waterbury OP Behavioral Health Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Waterbury, CT
    • NPI 1962760561

    O20120828000409

    Same enrollment
  • Wellmore, Inc.
    • Adolescent and Children Mental Health Clinic/Center
    • Waterbury, CT
    • NPI 1841379013

    O20120828000409

    Same enrollment

National Provider Directory

National Provider Directory

Locations

141 E Main St
Waterbury, CT 06702
Phone (203) 575-0466

141 E Main St
Fl 2
Waterbury, CT 06702
Phone (203) 723-9599

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402444800000",
    "number": "1336407915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 E MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021701",
            "telephone_number": "203-574-9000",
            "fax_number": "203-574-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 GRIGGS ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067043110",
            "telephone_number": "203-574-1419",
            "fax_number": "203-578-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMORE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-02",
        "last_updated": "2014-06-11",
        "status": "A",
        "authorized_official_last_name": "STECK",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "203-574-9000",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004039202",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellmore, Inc.-Therapeutic Shelter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.