Provider Demographics
NPI:1174148076
Name:SPARK HEALTHCARE LLC
Entity type:Organization
Organization Name:SPARK HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MASSETTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:480-227-0630
Mailing Address - Street 1:8390 E VIA DE VENTURA STE F110-301
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3188
Mailing Address - Country:US
Mailing Address - Phone:602-962-6515
Mailing Address - Fax:602-962-6516
Practice Address - Street 1:8906 NORTH 80TH PLACE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2132
Practice Address - Country:US
Practice Address - Phone:602-962-6515
Practice Address - Fax:602-962-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty