Provider Demographics
NPI:1063788123
Name:SPIRIT HOMECARE, LLC
Entity type:Organization
Organization Name:SPIRIT HOMECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MHSA
Authorized Official - Phone:515-987-9090
Mailing Address - Street 1:12026 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2317
Mailing Address - Country:US
Mailing Address - Phone:515-987-9090
Mailing Address - Fax:866-261-4796
Practice Address - Street 1:12026 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-2317
Practice Address - Country:US
Practice Address - Phone:515-987-9090
Practice Address - Fax:866-261-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
4068225OtherUHC
03219226OtherAMERIGROUP
IA1063788123Medicaid
64057376OtherAMERIHEALTH CARITAS
03219226OtherAMERIGROUP