Provider Demographics
NPI:1497409767
Name:SPARTAN HEALTH ALLIANCE LLC
Entity Type:Organization
Organization Name:SPARTAN HEALTH ALLIANCE LLC
Other - Org Name:SUNTREE PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:IV
Authorized Official - Credentials:APRN, FNP-C, PMHNP
Authorized Official - Phone:954-205-4551
Mailing Address - Street 1:3040 N WICKHAM RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2369
Mailing Address - Country:US
Mailing Address - Phone:321-456-9653
Mailing Address - Fax:321-204-9168
Practice Address - Street 1:3040 N WICKHAM RD STE 3
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-456-9653
Practice Address - Fax:321-204-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty