Provider Demographics
NPI:1386331114
Name:SPARK HOME CARE LLC
Entity type:Organization
Organization Name:SPARK HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:917-805-0702
Mailing Address - Street 1:3600 ROUTE 66 STE 150
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2645
Mailing Address - Country:US
Mailing Address - Phone:732-722-9992
Mailing Address - Fax:732-242-7922
Practice Address - Street 1:3600 ROUTE 66 STE 150
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2645
Practice Address - Country:US
Practice Address - Phone:732-722-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care