=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982434502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A SPARK OF HOPE HOME CARE L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2024
-----------------------------------------------------
Last Update Date | 08/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36038 HUNTER AVE APT 11304
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48185-6656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-693-5509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36038 HUNTER AVE APT 11304
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48185-6656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-693-5509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. TENISHA LASHOUN LINDSEY
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 313-980-0290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------