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General NPI Number Information
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NPI Number | 1215990734
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Entity Type | Organization
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Legal Business Name | SPECTRACARE HEALTH SYSTEMS, INC.
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 134 PREVATT RD
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City | DOTHAN
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State | AL
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Zip | 36301-5427
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Country | US
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Telephone | 334-794-0731
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Fax | 334-671-9199
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Provider Business Mailing Address
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Address Line | PO BOX 1245 2694 SOUTH PARK AVE.
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City | DOTHAN
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State | AL
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Zip | 36302-1245
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Country | US
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Telephone | 334-712-2720
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Fax | 334-712-2727
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MELISSA KIRKLAND
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Credential |
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Telephone | 334-712-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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