Organization
LIFESPARK HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY C IWEAJUNWA FNP-C (MANAGER)
(763) 442-0749
Entity
Organization
Contact information
Practice address
24931 SIGNORELLI WAY, KATY, TX 77493-4268
(763) 442-0749
Mailing address
24931 SIGNORELLI WAY, KATY, TX 77493-4268
(763) 442-0749
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/21/2021
Last updated
11/21/2021
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