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General NPI Number Information
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NPI Number | 1164577391
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Entity Type | Organization
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Legal Business Name | SPECTRUM COMMUNITY SERVICES
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 28303 JOY RD
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City | WESTLAND
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State | MI
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Zip | 48185
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Country | US
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Telephone | 616-241-6258
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Fax | 616-241-6470
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Provider Business Mailing Address
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Address Line | 28303 JOY RD
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City | WESTLAND
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State | MI
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Zip | 48185
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Country | US
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Telephone | 616-241-6258
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Fax | 616-241-6470
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SHARON KAY BLAIN
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Credential |
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Telephone | 616-241-6258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | AS820092071
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License Number State | MI
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