Healthcare Provider Details

I. General information

NPI: 1194936765
Provider Name (Legal Business Name): SPECTRUM CARE ACADEMY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 LICK FORK RD
LONDON KY
40741-9534
US

IV. Provider business mailing address

PO BOX 911
COLUMBIA KY
42728-0911
US

V. Phone/Fax

Practice location:
  • Phone: 606-862-6664
  • Fax: 606-862-6783
Mailing address:
  • Phone: 270-384-6444
  • Fax: 270-384-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number950024
License Number StateKY

VIII. Authorized Official

Name: LISA LOY
Title or Position: ACCOUNTANT
Credential:
Phone: 270-384-6402