Provider Demographics
NPI:1992234660
Name:THE SPARC FOUNDATION, INC.
Entity type:Organization
Organization Name:THE SPARC FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:285-523-7718
Mailing Address - Street 1:225 E CHESTNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2582
Mailing Address - Country:US
Mailing Address - Phone:828-552-3771
Mailing Address - Fax:828-319-2812
Practice Address - Street 1:225 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2577
Practice Address - Country:US
Practice Address - Phone:828-552-3771
Practice Address - Fax:828-319-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health