Healthcare Provider Details

I. General information

NPI: 1487608485
Provider Name (Legal Business Name): SPECTRUM HEALTH SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 LINCOLN ST
WORCESTER MA
01605-1906
US

IV. Provider business mailing address

10 MECHANIC ST. SUITE 302
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-854-3320
  • Fax:
Mailing address:
  • Phone: 508-792-5400
  • Fax: 508-831-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHERRY ANN ELLIS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 508-792-5400