Provider Demographics
NPI:1003328733
Name:SPIRIT CARE SERVICES INC
Entity type:Organization
Organization Name:SPIRIT CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-292-8494
Mailing Address - Street 1:6717 BRANCH RD S
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-4377
Mailing Address - Country:US
Mailing Address - Phone:901-292-8494
Mailing Address - Fax:662-893-2278
Practice Address - Street 1:9925 HIGHWAY 178
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3213
Practice Address - Country:US
Practice Address - Phone:901-292-8494
Practice Address - Fax:662-932-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care