Healthcare Provider Details

I. General information

NPI: 1720448459
Provider Name (Legal Business Name): SPECTRUM BEHAVIORAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 NW 2ND AVENUE SUITE 402
BOCA RATON FL
33431-4160
US

IV. Provider business mailing address

4700 NW 2ND AVENUE SUITE 402
BOCA RATON FL
33431-4160
US

V. Phone/Fax

Practice location:
  • Phone: 561-491-2335
  • Fax: 561-989-0698
Mailing address:
  • Phone: 561-491-2335
  • Fax: 561-989-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA B BENSMIHEN
Title or Position: CEO
Credential: MBA
Phone: 561-491-2335