Provider Demographics
NPI:1639455967
Name:SPIIRIT HOME CARE AGENCY
Entity Type:Organization
Organization Name:SPIIRIT HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-965-0546
Mailing Address - Street 1:9635 SOUTHERN PINE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5558
Mailing Address - Country:US
Mailing Address - Phone:704-965-0546
Mailing Address - Fax:704-749-3862
Practice Address - Street 1:9635 SOUTHERN PINE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5558
Practice Address - Country:US
Practice Address - Phone:704-965-0546
Practice Address - Fax:704-749-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4473253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care