Healthcare Provider Details

I. General information

NPI: 1821859703
Provider Name (Legal Business Name): SPRINGFORTH HOLISTIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 W NORTHERN AVE STE D208
PHOENIX AZ
85021-4928
US

IV. Provider business mailing address

42304 W RAMIREZ DR
MARICOPA AZ
85138-1819
US

V. Phone/Fax

Practice location:
  • Phone: 623-428-1225
  • Fax:
Mailing address:
  • Phone: 602-387-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERIN STARK
Title or Position: SR RCM SME
Credential:
Phone: 317-225-0489