Healthcare Provider Details

I. General information

NPI: 1215990734
Provider Name (Legal Business Name): SPECTRACARE HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 PREVATT RD
DOTHAN AL
36301-5427
US

IV. Provider business mailing address

PO BOX 1245 2694 SOUTH PARK AVE.
DOTHAN AL
36302-1245
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-0731
  • Fax: 334-671-9199
Mailing address:
  • Phone: 334-712-2720
  • Fax: 334-712-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA KIRKLAND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 334-712-2720