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General NPI Number Information
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NPI Number | 1912306663
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Entity Type | Organization
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Legal Business Name | SPRING OF LIFE HEALTH CARE SERVICES, INC
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 6111 HARRISON ST SUITE 104
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2969
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Country | US
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Telephone | 757-472-5680
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 HARRISON ST SUITE 104
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2969
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Country | US
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Telephone | 757-472-5680
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NAAVA L WEST
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Credential |
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Telephone | 757-472-5680
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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 | IN
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