Provider Demographics
NPI:1396202511
Name:SPRAOUT CARE LLC
Entity type:Organization
Organization Name:SPRAOUT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:SAB
Authorized Official - Suffix:
Authorized Official - Credentials:CAC II
Authorized Official - Phone:240-350-9677
Mailing Address - Street 1:7603 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1617
Mailing Address - Country:US
Mailing Address - Phone:240-350-9677
Mailing Address - Fax:
Practice Address - Street 1:7603 GEORGIA AVE NW STE 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1617
Practice Address - Country:US
Practice Address - Phone:202-601-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-24
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities