Provider Demographics
NPI:1659724227
Name:SPARK HOME HEALTH, LLC
Entity Type:Organization
Organization Name:SPARK HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAIL-STENCEL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:720-353-8939
Mailing Address - Street 1:1325 S COLORADO BLVD STE B312
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3335
Mailing Address - Country:US
Mailing Address - Phone:720-479-8952
Mailing Address - Fax:888-981-8064
Practice Address - Street 1:1325 S COLORADO BLVD STE B312
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3303
Practice Address - Country:US
Practice Address - Phone:720-951-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000155766Medicaid