Provider Demographics
NPI:1952717043
Name:SPRUILL, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SPRUILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-3323
Mailing Address - Country:US
Mailing Address - Phone:919-344-8846
Mailing Address - Fax:
Practice Address - Street 1:904 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8625
Practice Address - Country:US
Practice Address - Phone:919-344-8846
Practice Address - Fax:919-288-2995
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-096-254311ZA0620X
NCMHL-096-255311ZA0620X
NCMHL-031-075311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home