Provider Demographics
NPI:1225608912
Name:SELECTIS SPARTA LLC
Entity Type:Organization
Organization Name:SELECTIS SPARTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-449-2100
Mailing Address - Street 1:60 PROVIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-1601
Mailing Address - Country:US
Mailing Address - Phone:706-444-5153
Mailing Address - Fax:706-444-8875
Practice Address - Street 1:60 PROVIDENCE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-1601
Practice Address - Country:US
Practice Address - Phone:706-444-5153
Practice Address - Fax:706-444-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility