Provider Demographics
NPI:1710720479
Name:WESTSPAN ENTERPRISE LLC
Entity type:Organization
Organization Name:WESTSPAN ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-579-3383
Mailing Address - Street 1:5270 ROUTE 115 UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BLAKESLEE
Mailing Address - State:PA
Mailing Address - Zip Code:18610-7853
Mailing Address - Country:US
Mailing Address - Phone:570-579-3383
Mailing Address - Fax:
Practice Address - Street 1:5270 ROUTE 115 UNIT 35270
Practice Address - Street 2:
Practice Address - City:BLAKESLEE
Practice Address - State:PA
Practice Address - Zip Code:18610-7853
Practice Address - Country:US
Practice Address - Phone:570-579-3383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care