Provider Demographics
NPI:1285111088
Name:TSPC-GA, LLC
Entity type:Organization
Organization Name:TSPC-GA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-486-4100
Mailing Address - Street 1:101 EDGEWATER DRIVE, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1262
Mailing Address - Country:US
Mailing Address - Phone:781-486-4100
Mailing Address - Fax:
Practice Address - Street 1:2278 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2032
Practice Address - Country:US
Practice Address - Phone:478-287-4165
Practice Address - Fax:678-388-4443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE SKILLED PEDIATRIC CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-24
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care