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General NPI Number Information
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NPI Number | 1235509530
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Entity Type | Organization
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Legal Business Name | SPECTRUM SUPPORTS COORDINATION
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 470 CARNEGIE DR
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City | PITTSBURGH
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State | PA
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Zip | 15243-2042
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Country | US
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Telephone | 412-571-1481
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Fax |
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Provider Business Mailing Address
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Address Line | 470 CARNEGIE DR
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City | PITTSBURGH
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State | PA
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Zip | 15243-2042
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Country | US
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Telephone | 412-571-1481
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOAH HACKETT
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Credential |
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Telephone | 412-571-1481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1030220130001
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License Number State | PA
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