Healthcare Provider Details

I. General information

NPI: 1568590438
Provider Name (Legal Business Name): SPARK LIFE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24456 HIGHWAY 371
SAREPTA LA
71071-3501
US

IV. Provider business mailing address

PO BOX 351
SAREPTA LA
71071-0351
US

V. Phone/Fax

Practice location:
  • Phone: 318-847-4356
  • Fax: 318-847-4644
Mailing address:
  • Phone: 318-847-4356
  • Fax: 318-847-4644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberADC2270
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY VOLLMER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 318-847-4356