Basic Information
| Provider Information | |||||||||
| NPI: | 1396155834 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE SPARC NETWORK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8879 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288148879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283297264 | ||||||||
| FaxNumber: | 8663385921 | ||||||||
| Practice Location | |||||||||
| Address1: | 5200 PARK RD STE 218B | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287854100 | ||||||||
| FaxNumber: | 8287851459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZORN | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8287760551 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.