MEDICARE: SPARK HEALTH AT HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	163W00000X	Registered Nurse
3	171M00000X	Case Manager/Care Coordinator
4	2080A0000X	Pediatric Adolescent Medicine Physician
5	224Z00000X	Occupational Therapy Assistant
6	225100000X	Physical Therapist
7	225200000X	Physical Therapy Assistant
8	225X00000X	Occupational Therapist
9	235Z00000X	Speech-Language Pathologist
10	252Y00000X	Early Intervention Provider Agency
11	261Q00000X	Clinic/Center
12	261QE0002X	Emergency Care Clinic/Center
13	363L00000X	Nurse Practitioner
14	363LP0200X	Pediatric Nurse Practitioner
15	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154957942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARK HEALTH AT HOME LLC

Provider Business Mailing Address
First Line	:	1325 S COLORADO BLVD STE B312
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3335
Country	:	US
Telephone Number	:	720-479-8952
Fax Number	:	888-981-8064

Provider Business Practice Location Address
First Line	:	1325 S COLORADO BLVD STE B312
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3335
Country	:	US
Telephone Number	:	720-479-8952
Fax Number	:	888-981-8064

Authorized Official
Title or Position	:	CEO
Name	:	SUZANNE HAKAR
Credential	:
Telephone Number	:	720-479-8952

Provider Enumeration Date	:	03/12/2020
Last Update Date	:	01/05/2023

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Directions to “SPARK HEALTH AT HOME LLC ” Practice Location

Language	Start Address	Practice Location

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