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General NPI Number Information
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NPI Number | 1659625929
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Entity Type | Organization
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Legal Business Name | SPIRIT HOMECARE, LLC
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 10506 BURT CIR
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City | OMAHA
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State | NE
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Zip | 68114-2094
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Country | US
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Telephone | 402-504-4658
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Fax | 402-505-6152
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Provider Business Mailing Address
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Address Line | 13375 UNIVERSITY AVE SUITE 200
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City | CLIVE
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State | IA
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Zip | 50325-8261
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Country | US
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Telephone | 515-221-9155
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Fax | 515-221-9157
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRUCE TEAGUE
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Credential |
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Telephone | 515-221-9155
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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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