Healthcare Provider Details

I. General information

NPI: 1730750407
Provider Name (Legal Business Name): SPECTRUM PRIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LINCOLN OAK DR
MODESTO CA
95355-9435
US

IV. Provider business mailing address

2400 LINCOLN OAK DR
MODESTO CA
95355-9435
US

V. Phone/Fax

Practice location:
  • Phone: 209-484-4600
  • Fax:
Mailing address:
  • Phone: 209-484-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WILLIAM GRIFFITHS
Title or Position: CEO
Credential: MBA
Phone: 209-484-4600