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General NPI Number Information
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NPI Number | 1326893132
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Entity Type | Organization
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Legal Business Name | SPUR OF LIFE
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 5200 WILLSON RD STE 150
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City | EDINA
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State | MN
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Zip | 55424-1332
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Country | US
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Telephone | 612-423-7904
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Fax | 612-520-5993
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Provider Business Mailing Address
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Address Line | 121 83RD AVE NE APT 309
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City | FRIDLEY
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State | MN
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Zip | 55432-1889
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Country | US
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Telephone | 612-423-7904
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Fax | 612-520-5993
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | CHEENA TOWEH
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Credential |
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Telephone | 612-423-7904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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