Healthcare Provider Details

I. General information

NPI: 1750597431
Provider Name (Legal Business Name): SPARKS AND EDINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 S WILLIS ST STE 209
ABILENE TX
79605-4048
US

IV. Provider business mailing address

1290 S WILLIS ST STE 209
ABILENE TX
79605-4048
US

V. Phone/Fax

Practice location:
  • Phone: 325-690-5913
  • Fax: 325-690-1890
Mailing address:
  • Phone: 325-690-5913
  • Fax: 325-690-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number009922
License Number StateTX

VIII. Authorized Official

Name: SHIRLEY JEAN SPARKS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 325-690-5913