Provider Demographics
NPI:1013684307
Name:SPADA, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SPADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RIVER MILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-8112
Mailing Address - Country:US
Mailing Address - Phone:413-531-0995
Mailing Address - Fax:
Practice Address - Street 1:7 RIVER MILLS DR
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-8112
Practice Address - Country:US
Practice Address - Phone:413-531-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility