Basic Information
| Provider Information | |||||||||
| NPI: | 1659625929 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPIRIT HOMECARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13375 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152219155 | ||||||||
| FaxNumber: | 5152219157 | ||||||||
| Practice Location | |||||||||
| Address1: | 10506 BURT CIR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681142094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025044658 | ||||||||
| FaxNumber: | 4025056152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2012 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | TEAGUE | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5152219155 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.