MEDICARE: STACY J SPENCE & ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	R3580	MD

General Provider Information

NPI Number	:	1407258361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACY J SPENCE & ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	3040 MITCHELLVILLE RD
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-1388
Country	:	US
Telephone Number	:	301-358-0744
Fax Number	:	301-715-3735

Provider Business Practice Location Address
First Line	:	3040 MITCHELLVILLE RD
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-1388
Country	:	US
Telephone Number	:	301-358-0744
Fax Number	:	301-715-3735

Authorized Official
Title or Position	:	OWNER /PRESIDENT
Name	:	STACY J SPENCE
Credential	:
Telephone Number	:	301-358-0744

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	09/23/2014

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