Provider Demographics
NPI:1144974403
Name:SPOLI CORP
Entity type:Organization
Organization Name:SPOLI CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-451-1245
Mailing Address - Street 1:1157 JOHN ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-4173
Mailing Address - Country:US
Mailing Address - Phone:386-441-6045
Mailing Address - Fax:
Practice Address - Street 1:1157 JOHN ANDERSON DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-4173
Practice Address - Country:US
Practice Address - Phone:386-441-6045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHESDA MANOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL676245096Medicaid