Provider Demographics
NPI:1184387474
Name:A SPARK OF POSSIBILITIES
Entity type:Organization
Organization Name:A SPARK OF POSSIBILITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:BNS, PHN
Authorized Official - Phone:763-260-0182
Mailing Address - Street 1:555 RAILROAD DR NW STE D
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1469
Mailing Address - Country:US
Mailing Address - Phone:763-260-1820
Mailing Address - Fax:
Practice Address - Street 1:555 RAILROAD DR NW STE D
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1469
Practice Address - Country:US
Practice Address - Phone:763-260-0182
Practice Address - Fax:763-577-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No251J00000XAgenciesNursing Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1487255121Medicaid