MEDICARE: SPRINGFORTH HOLISTIC HEALTH 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1821859703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGFORTH HOLISTIC HEALTH LLC

Provider Business Mailing Address
First Line	:	42304 W RAMIREZ DR
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-1819
Country	:	US
Telephone Number	:	602-387-0189
Fax Number	:

Provider Business Practice Location Address
First Line	:	2224 W NORTHERN AVE STE D208
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4928
Country	:	US
Telephone Number	:	623-428-1225
Fax Number	:

Authorized Official
Title or Position	:	SR RCM SME
Name	:	ERIN STARK
Credential	:
Telephone Number	:	317-225-0489

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	06/11/2026

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