Provider Demographics
NPI:1821616855
Name:SPARK LLC
Entity Type:Organization
Organization Name:SPARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-334-0657
Mailing Address - Street 1:10714 ZARTMAN RD
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-9202
Mailing Address - Country:US
Mailing Address - Phone:740-334-0657
Mailing Address - Fax:
Practice Address - Street 1:10714 ZARTMAN RD
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-9202
Practice Address - Country:US
Practice Address - Phone:740-334-0657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services