Provider Demographics
NPI:1962398099
Name:SPARK CARE HOME HEALTH SERVICES LLC.
Entity type:Organization
Organization Name:SPARK CARE HOME HEALTH SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:NASRIN
Authorized Official - Middle Name:SALIM
Authorized Official - Last Name:OMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-795-1157
Mailing Address - Street 1:140 W 98TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4800
Mailing Address - Country:US
Mailing Address - Phone:651-795-1157
Mailing Address - Fax:
Practice Address - Street 1:140 W 98TH ST STE 103
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4800
Practice Address - Country:US
Practice Address - Phone:651-795-1157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health