Spa, Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

SPA, INC.

Practice address

23221 Old US 20
Elkhart, IN 46516-9772

Phone

(574) 522-8338

Fax

(574) 742-6118

NPI assigned

Dec 17, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Carrie Zickefoose, MSW

Title

Executive Director

Phone

(574) 522-8338

Specialties & licenses 1

Addresses

Other names 1

• SPA Women's Ministry Homes Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1417428400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23221 OLD US 20 EAST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169772",
            "telephone_number": "574-522-8338",
            "fax_number": "574-742-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23221 OLD US 20",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169772",
            "telephone_number": "574-522-8338",
            "fax_number": "574-742-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "ZICKEFOOSE",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "574-522-8338",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPA Women's Ministry Homes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Substance Abuse Rehabilitation Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.