Healthcare Provider Details

I. General information

NPI: 1548874357
Provider Name (Legal Business Name): SPARKS SPECIAL NEEDS PEOPLE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 BLUESTONE RD
SOUTH EUCLID OH
44121-3427
US

IV. Provider business mailing address

4217 BLUESTONE RD
SOUTH EUCLID OH
44121-3427
US

V. Phone/Fax

Practice location:
  • Phone: 440-321-2983
  • Fax:
Mailing address:
  • Phone: 440-321-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KARI J MARX
Title or Position: CEO
Credential:
Phone: 440-321-2983