Provider Demographics
NPI:1912306663
Name:SPRING OF LIFE HEALTH CARE SERVICES, INC
Entity Type:Organization
Organization Name:SPRING OF LIFE HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NAAVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-472-5680
Mailing Address - Street 1:6111 HARRISON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2969
Mailing Address - Country:US
Mailing Address - Phone:757-472-5680
Mailing Address - Fax:
Practice Address - Street 1:6111 HARRISON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2969
Practice Address - Country:US
Practice Address - Phone:757-472-5680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health