Provider Demographics
NPI:1487446829
Name:SPARK OF LIFE IN HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:SPARK OF LIFE IN HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:RAXONNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:727-353-2939
Mailing Address - Street 1:22 HERITAGE DR APT B
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2740
Mailing Address - Country:US
Mailing Address - Phone:727-353-2939
Mailing Address - Fax:727-748-0561
Practice Address - Street 1:22 HERITAGE DR APT B
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2740
Practice Address - Country:US
Practice Address - Phone:727-353-2939
Practice Address - Fax:727-748-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care