MEDICARE: SPERICARE INNOVATIVE HEALTHCARE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1982464780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPERICARE INNOVATIVE HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	9900 RICHMOND AVE APT 813
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4538
Country	:	US
Telephone Number	:	713-347-1973
Fax Number	:	713-347-2837

Provider Business Practice Location Address
First Line	:	9900 RICHMOND AVE APT 813
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4538
Country	:	US
Telephone Number	:	713-347-1973
Fax Number	:	713-347-2837

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. TRAVIS KENNETH LANE
Credential	:
Telephone Number	:	713-347-1973

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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