MEDICARE: S.P.A.N. HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1093973208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S.P.A.N. HOME CARE

Provider Business Mailing Address
First Line	:	4134 ALMOND LAKE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-6770
Country	:	US
Telephone Number	:	713-738-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	4134 ALMOND LAKE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-6770
Country	:	US
Telephone Number	:	713-738-1011
Fax Number	:

Authorized Official
Title or Position	:	C.E.O.
Name	:	MR. RONALD EUGENE BOOKER SR.
Credential	:
Telephone Number	:	713-738-1011

Provider Enumeration Date	:	05/26/2008
Last Update Date	:	05/26/2008

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