Healthcare Provider Details

I. General information

NPI: 1659949055
Provider Name (Legal Business Name): SPERO HEALTH OF WEST VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ROSEBUD PLZ STE 104
CLARKSBURG WV
26301-9823
US

IV. Provider business mailing address

155 FRANKLIN RD STE 430
BRENTWOOD TN
37027-1602
US

V. Phone/Fax

Practice location:
  • Phone: 615-265-0371
  • Fax:
Mailing address:
  • Phone: 615-265-0371
  • Fax: 615-844-9033

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 Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD DULANY ADAMS
Title or Position: CFO
Credential:
Phone: 615-265-0371