Healthcare Provider Details

I. General information

NPI: 1316862519
Provider Name (Legal Business Name): SPARKS WINN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 W 137TH PL
HAWTHORNE CA
90250-6907
US

IV. Provider business mailing address

1107 S LA BREA AVE
INGLEWOOD CA
90301-3819
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-5900
  • Fax:
Mailing address:
  • Phone: 310-679-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNETTA LENISE SPARKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-679-5900