MEDICARE: SPARKS ENTERPRISES AND HOME CARE SERVICES, LLC.

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	152983LGB	GA

General Provider Information

NPI Number	:	1629334826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARKS ENTERPRISES AND HOME CARE SERVICES, LLC.

Provider Business Mailing Address
First Line	:	3666 GARRISON DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2214
Country	:	US
Telephone Number	:	404-380-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	3666 GARRISON DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2214
Country	:	US
Telephone Number	:	404-380-4636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LOIS E WEBB
Credential	:
Telephone Number	:	404-380-4636

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/02/2012

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