Provider Demographics
NPI:1619623345
Name:QUALITY LIFE SPANN HOME CARE LLC
Entity Type:Organization
Organization Name:QUALITY LIFE SPANN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM-SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-533-0622
Mailing Address - Street 1:1610 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2523
Mailing Address - Country:US
Mailing Address - Phone:215-277-7941
Mailing Address - Fax:
Practice Address - Street 1:1610 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2523
Practice Address - Country:US
Practice Address - Phone:215-277-7941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care