Provider Demographics
NPI:1306284781
Name:SPIRIT SENT HEALTH CARE SERVICES, INC
Entity type:Organization
Organization Name:SPIRIT SENT HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-843-1966
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0577
Mailing Address - Country:US
Mailing Address - Phone:907-843-1966
Mailing Address - Fax:
Practice Address - Street 1:3819 COUMBINE CIRCLE
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576-0577
Practice Address - Country:US
Practice Address - Phone:907-843-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK985585261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health