Organization
SPA, INC.
Active
Other names
SPA Women's Ministry Homes
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARRIE ZICKEFOOSE MSW (EXECUTIVE DIRECTOR)
(574) 522-8338
Entity
Organization
Contact information
Practice address
23221 OLD US 20, ELKHART, IN 46516-9772
(574) 522-8338
(574) 742-6118
Mailing address
23221 OLD US 20 EAST, ELKHART, IN 46516-9772
(574) 522-8338
(574) 742-6118
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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