Provider Demographics
NPI:1770167637
Name:SPEARS COMMUNITY HOMES CHILD & FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:SPEARS COMMUNITY HOMES CHILD & FAMILY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIQUITA
Authorized Official - Middle Name:DENEEN
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-815-7632
Mailing Address - Street 1:1501 TANGLEROSE CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7843
Mailing Address - Country:US
Mailing Address - Phone:214-815-7632
Mailing Address - Fax:972-230-2935
Practice Address - Street 1:4420 BARSTOW BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75236-2102
Practice Address - Country:US
Practice Address - Phone:469-399-1747
Practice Address - Fax:972-230-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX823721974Medicaid