Sandra Spruill

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

MHL-096-255 Issued in NC

Practice address

904 National Dr
Goldsboro, NC 27534-8625

Phone

(919) 344-8846

Fax

(919) 288-2995

NPI assigned

Jul 9, 2014

Last updated

Sep 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Universal Group Home LLC

  • Adult Care Home Facility
  • Mount Olive, NC
  • NPI 1285033761
  NPD (past) Authorized official

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1952717043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 FOREST DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275343323",
            "telephone_number": "919-344-8846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 NATIONAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275348625",
            "telephone_number": "919-344-8846",
            "fax_number": "919-288-2995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPRUILL",
        "first_name": "SANDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-09",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-096-254",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-096-255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Amber Spangler, LCSWA
• Shannon Ivy Speece, ANP
• Lori Diane Spisak, MD
• Donna Mercer Spivey
• Springwell, LLC (WellSpring, LLC)
• Shelby Spruill
• Venayagaratnam Srikantha, P.A.
• Ramaswamy Vellore Sriraman, M.D.
• SSC Goldsboro Operating Company LLC (Brian Center Health & Rehabilitation - Goldsboro)
• Samantha Michelle St John, FNP-C

• Adult Care Home Facility in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.