Healthcare Provider Details

I. General information

NPI: 1659724227
Provider Name (Legal Business Name): SPARK HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S COLORADO BLVD STE B312
DENVER CO
80222-3303
US

IV. Provider business mailing address

1325 S COLORADO BLVD STE B312
DENVER CO
80222-3335
US

V. Phone/Fax

Practice location:
  • Phone: 720-951-0258
  • Fax:
Mailing address:
  • Phone: 720-479-8952
  • Fax: 888-981-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNY M VAIL-STENCEL
Title or Position: CO-OWNER/ADMINISTRATOR
Credential: SLP
Phone: 720-353-8939