Provider Demographics
NPI:1750597431
Name:SPARKS AND EDINGTON LLC
Entity type:Organization
Organization Name:SPARKS AND EDINGTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:325-690-5913
Mailing Address - Street 1:1290 S WILLIS ST STE 209
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4048
Mailing Address - Country:US
Mailing Address - Phone:325-690-5913
Mailing Address - Fax:325-690-1890
Practice Address - Street 1:1290 S WILLIS ST STE 209
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4048
Practice Address - Country:US
Practice Address - Phone:325-690-5913
Practice Address - Fax:325-690-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009922251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009922Medicare ID - Type UnspecifiedTEXAS STATE LICENSE
457924Medicare Oscar/Certification