Provider Demographics
NPI:1619283140
Name:SPIRIT OF LIFE- PERSONAL ASSISTANCE LIVING SERVICE
Entity Type:Organization
Organization Name:SPIRIT OF LIFE- PERSONAL ASSISTANCE LIVING SERVICE
Other - Org Name:SPIRIT OF LFE- PAL SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR/ WELLNESS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWANNA
Authorized Official - Middle Name:CHARGOIS
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:281-235-9247
Mailing Address - Street 1:15116 LEE RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-2097
Mailing Address - Country:US
Mailing Address - Phone:281-235-9247
Mailing Address - Fax:
Practice Address - Street 1:15116 LEE RD
Practice Address - Street 2:SUITE 520
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-2097
Practice Address - Country:US
Practice Address - Phone:281-235-9247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care