Provider Demographics
NPI:1740762020
Name:SPRING OF LIFE HEALTH CARE
Entity Type:Organization
Organization Name:SPRING OF LIFE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLEMENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MABUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-215-1140
Mailing Address - Street 1:3700 MAPLESHADE LN APT 2072
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6013
Mailing Address - Country:US
Mailing Address - Phone:469-215-1140
Mailing Address - Fax:
Practice Address - Street 1:3700 MAPLESHADE LN APT 2072
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6013
Practice Address - Country:US
Practice Address - Phone:469-215-1140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty