Provider Demographics
NPI:1043981830
Name:SPENCER SENIOR CARE
Entity Type:Organization
Organization Name:SPENCER SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAQUISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-210-4151
Mailing Address - Street 1:5269 CICERO DR
Mailing Address - Street 2:
Mailing Address - City:DARROW
Mailing Address - State:LA
Mailing Address - Zip Code:70725-2523
Mailing Address - Country:US
Mailing Address - Phone:225-210-4151
Mailing Address - Fax:
Practice Address - Street 1:1909 N AIRLINE HWY APT 223
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2149
Practice Address - Country:US
Practice Address - Phone:225-210-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health