Provider Demographics
NPI:1588705222
Name:SPARK LIFE SERVICES
Entity type:Organization
Organization Name:SPARK LIFE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-847-4356
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:SAREPTA
Mailing Address - State:LA
Mailing Address - Zip Code:71071-0351
Mailing Address - Country:US
Mailing Address - Phone:318-847-4356
Mailing Address - Fax:318-847-4644
Practice Address - Street 1:24456 HIGHWAY 371
Practice Address - Street 2:
Practice Address - City:SAREPTA
Practice Address - State:LA
Practice Address - Zip Code:71071-3501
Practice Address - Country:US
Practice Address - Phone:318-847-4356
Practice Address - Fax:318-847-4356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X, 261QA0600X, 261QD1600X, 251C00000X, 253Z00000X
LAPCA 3697251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251G00000XAgenciesHospice Care, Community Based
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1963224Medicaid